The Availability of Skin Perfussion Pressure Measurement in the Prediction of Ischemic Limb Ulcer Healing

Ho, Jung Ki; Suh, Bo Yang; Kwun, Woo Hyung; Kwun, Koing Bo

Abstract

PURPOSE: Critical limb ischemia (CLI) is equated with a need for limb salvage. We studied whether measurement of skin perfusion pressure (SPP) can be used to accurately identify the ampuation level of those patients with CLI who require major amputation and predict the patients whose foot ischemic ulcer would heal or not after vasodilator treatment for over 4 weeks.
METHODS
Fifty-one patients with a nonhealing foot ulcer were studied prospectively at Yeungnam university hospital. Age range was 46 to 78 years old with average 68 years old and male to female ratio was 3.3:1. Patients were included in the study if informed consent for medication of vasodilators was obtained, and patients were excluded if there was uncontrolled sepsis or if they required imminent amputation. We used PGE1 (Opalmon(R), 6 tablets/day #3 for 6 weeks, 100 mg/tablet) in 20 cases, PGI2 (Beraprost(R), 6 tablets/day, #3 for 6 weeks, 20 mg/tablet) in 16 cases and Argatroban (antithrombin: Novastan(R) 2 amples/day #2 IV for 4 weeks, 10 mg/ample) in 15 cases. The ankle pressure was checked for each limb. Measurements of SPP were made with photoplethysmography (Life Sciences MVL Modulab(R)) at the metatarsal level which were mostly located at the proximal site of ulcer in viable tissue. The SPP measuements were compaired with the clnical results of therapy (group I: stop medication and major amputation in 7 cases, group II: failed to heal in 18 cases, group III: ulcer healed in 26 cases) in group II & III. We calculated overall acuracy of SPP measurement for prediction of limb ischemic ulcer healing.
RESULTS
The ankle pressure or Ankle Brachial Index (ABI) was not predictive of the need for the outcome of drugs therapy. Average SPPs were 12+/-6 mmHg in group I,27+/8 mmHg in group II and 45+/-7 mmHg in group III. The overall predictive accuracy of SPP over 40 mmHg for ulcer healing was 80%.
CONCLUSIONS
SPP measurement with PPG is an objective, easy and effective noninvasive method that can be used to predict ischemic ulcer healing.