Transcutaneous oxygen pressure. An effective measure for prosthesis fitting on below-knee amputations

Area of Science:

• Vascular Surgery
• Prosthetics and Orthotics
• Biomedical Engineering

Background:

• Lower limb amputation due to arterial occlusive disease presents challenges in stump healing and prosthesis adaptation.
• Tissue oxygenation is a critical factor influencing these outcomes.
• Transcutaneous oxygen tension (TcPO2) offers a noninvasive method to assess microcirculation in amputation stumps.

Purpose of the Study:

• To investigate the correlation between transcutaneous oxygen tension (TcPO2) levels and the success of below-knee stump healing and prosthesis adaptation.
• To establish critical TcPO2 thresholds for predicting stump healing and prosthetic fitting in patients with arterial occlusive disease.

Main Methods:

• A cohort of 46 below-knee stumps, without pre-existing prosthetic issues, were evaluated.
• Patients were followed for a mean duration of 23 months.
• TcPO2 measurements were taken on the anterior and exterior faces of the stumps in both reclined and seated positions.
• Stumps were categorized into prosthetic adaptation groups, from requiring further amputation to complete adaptation.

Main Results:

• Stump healing was unlikely with TcPO2 values below 15 mm Hg in the lying position.
• Healing was possible with TcPO2 above 20 mm Hg, but prosthesis socket contact was compromised below 40 mm Hg.
• Successful prosthesis fitting, without complications beyond vascular issues, was achievable when TcPO2 values exceeded 40 mm Hg.

Conclusions:

• TcPO2 is a significant predictor of below-knee stump healing and prosthesis adaptation post-amputation for arterial occlusive disease.
• Specific TcPO2 thresholds can guide clinical decisions regarding surgical management and prosthetic fitting.
• Maintaining adequate tissue oxygenation is paramount for optimizing patient outcomes after lower limb amputation.