A multivariate analysis of determinants of wound healing in patients after amputation for peripheral vascular disease

In a prospective study 53 patients undergoing amputations of the lower limb were evaluated for clinical criteria, laboratory results, pulse volume recordings, Doppler pressures, Photoplethysmographic Skin Perfusion Pressures (PPG/SPP) and angiography. The purpose of the study was to analyse which of these techniques predicts wound healing adequately after amputation. Forty-five patients eventually completed all tests. With the exception of PPG/SPP none of these tests were able to predict skin healing. The technique of PPG/SPP proved very reliable in helping to select the level of amputation, if measured anteriorly (P = 0.0001, r = 0.83). Angiographic scoring also correlated significantly (P = 0.0016) with a successful result. This study suggests that surgeons should not rely on their clinical acumen for the selection of the amputation level. In the absence of a reliable non-invasive test, angiography may well be useful but PPG/SPP will enable the surgeon to amputate on an optimal level and thus reduce complications and improve rehabilitation.