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Related Experiment Videos

Should chemical sympathectomy precede below knee amputation?

L Lantsberg1, M Goldman, J Khoda

  • 1Department of Surgery A, Ben-Gurion University of the Negev, Israel.

International Surgery
|January 1, 1996
PubMed
Summary

Chemical sympathectomy can improve below-knee skin blood flow in patients with severe limb ischemia. This intervention may enhance wound healing, offering a potential benefit for limb preservation.

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Area of Science:

  • Vascular Surgery
  • Ischemia Research
  • Regenerative Medicine

Background:

  • Severe limb ischemia presents a significant challenge in limb preservation.
  • Lumbar sympathectomy's role in managing limb ischemia remains debated.
  • Below-knee (BK) wound healing is critical for successful limb salvage.

Purpose of the Study:

  • To establish a critical value for below-knee (BK) skin flap healing using laser Doppler (LD) measurements.
  • To evaluate the efficacy of chemical sympathectomy in improving distal skin blood flow.
  • To determine if chemical sympathectomy can enhance wound healing in severe limb ischemia.

Main Methods:

  • Laser Doppler (LD) blood flow measurements were taken at the distal anterior below-knee skin flap in patients with severe limb ischemia.

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  • A critical LD value for primary BK healing was determined by comparing measurements in patients who healed versus those who underwent above-knee (AK) amputation.
  • The impact of chemical sympathectomy on LD blood flow was assessed by measuring before and after the procedure in a separate cohort.

    • Main Results:

    • A mean LD value of 42V in patients with primary BK healing contrasted with 11V in those proceeding to AK amputation (p < 0.001), establishing 20V as a critical healing threshold.
    • Chemical sympathectomy significantly increased LD values from a mean of 26V to 50V (p < 0.001).
    • In patients with initial LD levels below 20V, chemical sympathectomy elevated flow to levels conducive to BK healing in five out of seven cases.

    Conclusions:

    • Laser Doppler measurements can identify a critical threshold for below-knee wound healing in severe limb ischemia.
    • Chemical sympathectomy demonstrates a significant potential to improve below-knee skin blood flow.
    • Chemical sympathectomy may enhance primary wound healing and contribute to limb preservation strategies in severe limb ischemia.