The assessment of skin viability using fluorescein angiography prior to amputation

Fluorescein angiography was used for the preoperative assessment of skin viability and the determination of the level of amputation in patients with peripheral vascular disease. In twenty-two patients requiring twenty-seven lower-extremity amputations (including five revisions), a retrospective comparison was made between the surgeon's choice of amputation level based on clinical criteria and that based on the fluorescein angiogram. As was evident by the failure of the amputation to heal, the surgeon's prediction was too distal in nine (33 per cent) of twenty-seven amputations and revisions. The assessor of fluorescein angiograms predicted five of these nine failures; therefore, the failure rate could have been reduced to four (15 per cent) of twenty-seven amputations. The amputation level predicted on the basis of the fluorescein angiogram was unnecessarily high in three lower limbs (11 per cent). These three amputations healed at the level chosen by the surgeon, but did so by prolonged secondary healing. Fluorescein angiography is a simple, safe, and useful preoperative bedside technique for the assessment of skin viability and the determination of amputation level in patients with peripheral vascular disease.