SLR - August 2014 - James Averett, DPM
Reference: Ruangsetakit C, Chinsakchai K, Mahawongkajit P, Mutirangura P. Transcutaneous Oxygen Tension: A Useful Predictor of Ulcer Healing in Critical Limb Ischemia. J Wound Care. 2010 May; 19(5): 202-6.
Scientific Literature Review
Reviewed By: James Averett, DPM
Residency Program: Southern Arizona VA Health Care System
Podiatric Relevance: Peripheral arterial occlusive disease (PAOD) is a common manifestation of systemic atherosclerosis. Most patients with PAOD develop chronic ulcers, gangrene and rest pain, defined as critical limb ischemia. TcPO2 is an accurate, non-invasive predictor of ischemic ulcer healing.
Methods: Fifty patients with critical limb ischemia (chronic ischemic wounds or gangrene) utilized TcPO2 to predict healing rates. These patients were divided into three groups: Group 1 TcPO2 < 20mmHg, Group 2 TcPO2 20 – 40 mmHg and Group 3 TcPO2 > 40 mmHg. Group 2 was further divided into two subgroups of TcPO2 decreased by <10mmHg with leg elevation or TcPO2 decreased by >10mmHg with leg elevation. TcPO2 was then measured, ulcers were debrided amputations were performed as needed. Wound care was subsequently provided to all wounds. Outcomes were classified as either: (I) A healing ulcer, showed good epithelialization or granulation at both base and edges, or a decrease in ulcer area; or (II) non-healing that showed poor granulation tissue or a pale base and necrotic edges.
Results: Group 1 (TcPO2 < 20) showed no signs of ulcer healing. Group 3 (TcPO2 >40) all patients showed progress to healing. Group 2, sub group 1 (decrease by <10 with leg elevation) 8 of 10 patients healed (p<0.001). Group 2, sub group 2 (decreased by >10 with leg elevation) 1/12 patients healed (p<0.001).
Conclusions: TcPO2 measurment is an accurate, non-invasive predictor of ischemic ulcer healing where TcPO2 values are less than 20mmHg or more than 40mmHg. Leg elevation might also provide an important factor when assessing patients with borderline TcPO2 values. TcPO2 is a simple and cost-effective test that can be utilized in selecting appropriate treatment for patients with critical limb ischemia.