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Predicting Success of Forefoot Amputations in Diabetics by Noninvasive Testing

Predicting Success of Forefoot Amputations in Diabetics by Noninvasive Testing Abstract • Sixty-six diabetic patients underwent needed forefoot amputations when clinical assessment indicated a reasonable chance of healing. All patients underwent noninvasive testing consisting of segmental systolic pressure measurements and pulse volume recordings (PVRs) taken at the thigh, calf, ankle, and forefoot levels. Segmental systolic pressures were falsely high (>200 mm Hg) and therefore not useful in 56%. Ankle systolic pressures predicted failure in 36% of patients who healed and success in 64% who failed to heal. Segmental PVRs were sequentially predictive in only 50%. Forefoot PVR traces predicted failure in 50% of patients whose amputations healed. No patient should be denied a forefoot amputation solely on the basis of unfavorable results of noninvasive tests. Favorable clinical signs and a strongly positive forefoot PVR trace are the best predictors of successful forefoot amputations in diabetic patients. (Arch Surg 114:1034-1036, 1979) References 1. Bernstein EF: The noninvasive vascular diagnostic laboratory , in Najarian JS, Delaney JP (eds): Vascular Surgery . Miami, Symposia Specialists Inc, 1978, pp 33-46. 2. Carter SA: The relationship of distal systolic pressures to healing of skin lesions in limbs with arterial occlusive disease, with special reference to diabetes mellitus . Scand J Clin Lab Invest 31( (suppl 128) ):239, 1973. 3. Raines JK, Darling RC, Ruth J, et al: Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities . Surgery 79:21-28, 1976. 4. Yao JST, Bergan JJ: Application of ultrasound to arterial and venous diagnosis . Surg Clin North Am 54:23, 1974. 5. Darling RC, Raines JK, Brener BJ, et al: Quantitative segmental pulse volume recorder: A clinical tool . Surgery 72:873, 1972. 6. Marble A, Wheelock FC: Surgery in diabetes , in Marble A, White P, Bradley R, et al (eds): Joslin's Diabetes Mellitus . Philadelphia, Lea & Febiger, 1971, pp 599-620. 7. Strandess PE Jr, Sumner DS: Noninvasive methods of studying peripheral arterial function . J Surg Res 12:419, 1972.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Predicting Success of Forefoot Amputations in Diabetics by Noninvasive Testing

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1979.01370330056010
Publisher site
See Article on Publisher Site

Abstract

Abstract • Sixty-six diabetic patients underwent needed forefoot amputations when clinical assessment indicated a reasonable chance of healing. All patients underwent noninvasive testing consisting of segmental systolic pressure measurements and pulse volume recordings (PVRs) taken at the thigh, calf, ankle, and forefoot levels. Segmental systolic pressures were falsely high (>200 mm Hg) and therefore not useful in 56%. Ankle systolic pressures predicted failure in 36% of patients who healed and success in 64% who failed to heal. Segmental PVRs were sequentially predictive in only 50%. Forefoot PVR traces predicted failure in 50% of patients whose amputations healed. No patient should be denied a forefoot amputation solely on the basis of unfavorable results of noninvasive tests. Favorable clinical signs and a strongly positive forefoot PVR trace are the best predictors of successful forefoot amputations in diabetic patients. (Arch Surg 114:1034-1036, 1979) References 1. Bernstein EF: The noninvasive vascular diagnostic laboratory , in Najarian JS, Delaney JP (eds): Vascular Surgery . Miami, Symposia Specialists Inc, 1978, pp 33-46. 2. Carter SA: The relationship of distal systolic pressures to healing of skin lesions in limbs with arterial occlusive disease, with special reference to diabetes mellitus . Scand J Clin Lab Invest 31( (suppl 128) ):239, 1973. 3. Raines JK, Darling RC, Ruth J, et al: Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities . Surgery 79:21-28, 1976. 4. Yao JST, Bergan JJ: Application of ultrasound to arterial and venous diagnosis . Surg Clin North Am 54:23, 1974. 5. Darling RC, Raines JK, Brener BJ, et al: Quantitative segmental pulse volume recorder: A clinical tool . Surgery 72:873, 1972. 6. Marble A, Wheelock FC: Surgery in diabetes , in Marble A, White P, Bradley R, et al (eds): Joslin's Diabetes Mellitus . Philadelphia, Lea & Febiger, 1971, pp 599-620. 7. Strandess PE Jr, Sumner DS: Noninvasive methods of studying peripheral arterial function . J Surg Res 12:419, 1972.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1979

References

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