Prospective use of xenon Xe 133 clearance for amputation level selection

Area of Science:

• Vascular Surgery
• Nuclear Medicine
• Biomedical Engineering

Background:

• Amputation level selection is critical for successful wound healing.
• Assessing capillary blood flow is essential for predicting healing outcomes.
• Previous methods for determining blood flow at amputation sites have limitations.

Purpose of the Study:

• To evaluate the efficacy of Xenon Xe 133 clearance for selecting the optimal distal amputation level.
• To establish a reliable capillary blood flow threshold predictive of successful amputation stump healing.
• To correlate measured blood flow rates with healing success across various amputation levels.

Main Methods:

• Utilized Xenon Xe 133 clearance to measure capillary skin blood flow.
• Injected Xenon Xe 133 in saline intracutaneously at potential amputation levels.
• Employed a gamma camera and computer system with the modified Ketty-Schmidt formula to calculate flow rates.
• Analyzed data from 45 patients across multiple amputation levels.

Main Results:

• Identified a capillary skin blood flow rate of ≥ 2.6 mL/min/100 g of tissue as a healing threshold.
• All amputations in patients with flow rates > 2.4 mL/min/100 g of tissue healed, with only two exceptions.
• Demonstrated the method's applicability across diverse amputation levels, from toes to hip disarticulation.

Conclusions:

• Xenon Xe 133 clearance is an effective method for selecting optimal distal amputation levels.
• A capillary blood flow threshold of approximately 2.4-2.6 mL/min/100 g tissue is a strong predictor of successful amputation stump healing.
• This technique aids in reducing amputation revision rates by ensuring adequate perfusion for wound healing.