Predicting healing of lower limb ulcers

Area of Science:

• Vascular Surgery
• Wound Healing
• Diagnostic Techniques

Background:

• Ischaemic ulcers in patients with compromised peripheral arterial circulation require accurate assessment of arterial supply for effective management.
• Traditional methods like physical examination and ankle/brachial (ABI) or toe/brachial (TBI) index measurements have limitations in certain patient populations.

Purpose of the Study:

• To evaluate the efficacy of transcutaneous oxygen pressure (tcPO2) measurement in predicting the outcome of ischaemic ulcers.
• To compare the predictive value of tcPO2 with ABI and TBI in patients undergoing revascularization surgery.

Main Methods:

• Twenty-two patients with ischaemic ulcers and compromised peripheral arterial circulation underwent tcPO2 measurement.
• Ankle-brachial (ABI) and toe-brachial (TBI) indices were calculated for comparison.
• Wound healing outcomes were assessed two months post-surgery.

Main Results:

• Postoperative tcPO2 values were highly predictive of wound outcome (P < 0.001).
• A tcPO2 > 31 mmHg correlated with healing, while tcPO2 < 28 mmHg indicated indolent ulcers.
• ABI and TBI were not consistently calculable and showed no significant predictive value for outcome (ABI P = 0.152, TBI P = 0.069).
• Diabetic patients exhibited a diminished response to revascularization, with a lower mean tcPO2 increase compared to non-diabetic patients.

Conclusions:

• Transcutaneous oxygen pressure (tcPO2) measurement is a reliable technique for assessing arterial supply and predicting ischaemic ulcer healing.
• TcPO2 measurement offers a valuable tool to guide management decisions, particularly when ABI and TBI are unreliable.
• The study highlights potential differences in revascularization response between diabetic and non-diabetic patients based on tcPO2 changes.