Predictive value of routine transcutaneous tissue oxygen tension (tcpO2) measurement for the risk of non-healing and amputation in diabetic foot ulcer patients with non-palpable pedal pulses
Ruth Ladurner, Markus Küper, Ingmar Königsrainer, Stefan Löb, Dörte Wichmann, Alfred Königsrainer, Stephan Coerper, Stefan Beckert
Med Sci Monit 2010; 16(6): CR273-277
Background: It was evaluated whether transcutaneous tissue oxygen tension (tcpO2) measurement, when assessed in daily routine, can be used to predict the risk of non-healing and amputation in diabetic foot ulcer patients with non-palpable pedal pulses.
Material/Methods: Patients were followed up in an outpatient setting according to a comprehensive wound-care protocol. tcpO2 measurements were performed at the dorsum of the forefoot in a standardized setting. Patients were divided into three subgroups according to their initial tcpO2-readings (tcpO2 <20 mmHg, tcpO2 20–40 mmHg, tcpO2 >40 mmHg). Patients with clinical signs of soft tissue infection at the initial presentation were excluded.
Results: One hundred forty-one patients were enrolled. Wounds associated with a tcpO2 reading <20 mmHg demonstrated a significantly decreased probability of healing compared with those associated with a tcpO2 >40 mmHg (p=0.008). In addition, the risks of soft tissue infection (p=0.057) and hospitalization during follow-up (p=0.019) were different among the three groups. The overall amputation rate increased with decreasing tcpO2 (p=0.014) although there was no significant difference for major amputations (p=0.448).
Conclusions: Routine assessment of tcpO2 is suitable as a clinical screening tool for estimating the risk of non-healing in diabetic foot ulcer patients without palpable pedal pulses. However, its predictive value for the risk of amputation remains unclear.
Keywords: Risk, Predictive Value of Tests, Oxygen - blood, Middle Aged, Male, Humans, Female, Diabetic Foot - therapy, Amputation, Aged, 80 and over, Aged, Adult, Time Factors, Treatment Outcome, Wound Healing