Predictors for wound healing in ischemic lower limb amputation.

Determination of the level of amputation of an ischemic lower limb presents a difficult problem. This prospective study evaluated parameter capable of predicting wound healing in patients with peripheral vascular disease. Forty-four amputations performed on 38 patients for advanced ischemia of a lower extremity were analyzed. Among them, 20 patients had diabetes mellitus and 10 received vascular reconstruction prior to the amputation. All patients except one had a skin temperature measurement and 26 patients had segmental blood pressure measurements before amputation. Of the 44 amputations, 31 healed successfully and 13 failed to heal without further intervention. Patients who had an amputation above the ankle joint had a significantly better outcome than those who had amputation below the ankle joint. Among the amputations proximal to the ankle joint, all patients with segmental blood pressures > 70 mmHg at the amputation level had successful wound healing, compared with only half of those patients with segmental pressures < 70 mmHg. However, ankle segmental pressure was not associated with the outcome of wound healing in the amputations distal to the ankle joint. The absolute skin temperature and the difference between the skin and ambient temperature were found to be poor predictors for wound healing. No significant differences were detected among the successes and failures with regard to the patient's sex, age, blood chemistry and duration of diabetes mellitus.