Determination of amputation level in ischemic limbs. Reappraisal of the measurement of TcPo2.

OBJECTIVE

To study the accuracy of the measurement of TcPo2 for the determination of the optimal level of amputation in patients with end-stage vascular disease (i.e., the level at which the reamputation rate and the proportion of too-proximal amputations will be minimized).

RESEARCH DESIGN AND METHODS

We used a Medline literature search of all published studies of the past 12 years that fulfilled predefined quality criteria, and we analyzed the data by means of receiver operating characteristic (ROC) curve.

RESULTS

Ten studies could be identified with a total of 615 lower-limb amputations (51% of them being performed in diabetic patients) and a reamputation rate of 16.4%. The best performances of the TcPo2 measurement were obtained between 10 and 20 mmHg with an accuracy of approximately 80%.

CONCLUSIONS

Preoperative TcPo2 measurement may be of considerable help to predict stump outcome and level of amputation. Our study provides objective prognostic values for the range 0-50 mmHg and suggests that TcP02 should usually be 20 mmHg at the site of amputation, which will predict healing with 80% accuracy and should, therefore, not be used as a sole criteron. Despite this aid in making his decision about the amputation level, the surgeon still has to balance between his goal of achieving primary wound healing and his hope of preserving the maximal limb length and has to consider patient preferences.