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Unrecognized arteriosclerosis is associated with wound complications after below-knee amputation
Edward Gifford1, Christy Anthony1, Amy H Kaji2
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
Annals of Vascular Surgery
|November 30, 2014
Summary
Guillotine below-knee amputation (BKA) for wet gangrene complications are common. Microvascular disease, not peripheral arterial disease (PAD), predicts wound complications after BKA formalization.
Area of Science:
- Vascular Surgery
- Diabetic Complications
- Wound Healing
Background:
- Guillotine below-knee amputation (BKA) for wet gangrene is a serious complication of uncontrolled diabetes.
- Identifying risk factors for wound complications after amputation formalization is crucial.
Purpose of the Study:
- To examine risk factors associated with wound complications after guillotine BKA formalization in diabetic patients with wet gangrene.
- To determine if traditional markers of peripheral arterial disease (PAD) predict wound complications.
Main Methods:
- Retrospective review of 56 guillotine BKAs in 55 patients over 4 years.
- Evaluation of patients for PAD based on distal pulses.
- Analysis of patient history, interval between surgeries, pathology, and preformalization labs for significance.
Main Results:
- 32% of BKAs (18/56) experienced postformalization wound complications.
- Microvascular disease on pathology, but not history of PAD or other lab values, was predictive of wound complications (P=0.03).
- No association found between microvascular disease and history of PAD.
Conclusions:
- Traditional PAD markers do not predict wound complications after guillotine BKA formalization for wet gangrene.
- Assessment of microvascular disease may improve risk stratification for patients undergoing amputation.
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