Selection of amputation level. Comparison between morphine puncture test and skin perfusion pressure

Area of Science:

• Vascular Surgery
• Peripheral Arterial Disease
• Amputation Level Determination

Background:

• Peripheral occlusive arterial disease (POAD) often necessitates lower limb amputation.
• Accurate determination of amputation level is crucial for successful wound healing and limb salvage.
• Preoperative assessment tools aim to predict healing outcomes.

Purpose of the Study:

• To evaluate the utility of the morphine puncture test (MPT) and skin perfusion pressure (SPP) in guiding amputation level selection for patients with POAD.
• To compare the predictive value of MPT and SPP for below-knee (BK) amputation healing.
• To assess the potential impact of relying solely on MPT for amputation level determination.

Main Methods:

• Retrospective analysis of 46 amputations in patients with POAD.
• Preoperative assessment included the morphine puncture test (MPT) and local skin perfusion pressure (SPP) measurement.
• Below-knee (BK) amputation was performed if SPP was ≥ 40 mm Hg, with clinical judgment as a factor.
• Healing outcomes were analyzed based on MPT and SPP results.

Main Results:

• Out of 12 BK amputations with SPP ≥ 40 mm Hg but a negative MPT and no clinical skin changes, 11 healed successfully.
• If MPT had been the sole determinant, 11 knees might have been unnecessarily amputated.
• SPP ≥ 40 mm Hg correlated with successful BK amputation healing in this cohort.

Conclusions:

• The morphine puncture test (MPT) is not a suitable or reliable method for determining the optimal amputation level in patients with peripheral occlusive arterial disease.
• Skin perfusion pressure (SPP) measurement appears to be a more objective and reliable indicator for guiding below-knee amputation decisions.
• Utilizing SPP can potentially prevent unnecessary higher-level amputations and improve limb salvage rates.