Predicting healing of lower limb ulcers.

ABSTRACT

Management of ischaemic ulcers in patients with compromised peripheral arterial circulations relies on the physical examination and the simple, non-invasive assessment of arterial supply. This study aims to determine if transcutaneous oxygen pressure (tcPO2) measurement can improve management decisions based on ankle or toe systolic blood pressure measurement. Twenty-two consecutive patients with ischaemic ulcers had tcPO2 measured and the ankle/brachial (ABI) and toe/brachial (TBI) indices calculated. Two months after surgery 12 of 22 (55%) ulcers were healing and 10 (45%) were indolent. Postoperative tcPO2 values were predictive of wound outcome (P < 0.001). A tcPO2 > 31 mmHg was invariably associated with healing whilst a tcPO2 < 28 mmHg was associated with indolence. Ankle/brachial indices and TBI were unable to be calculated in all patients due to falsely elevated pressures and hallux amputations, respectively, and neither was predictive of outcome (ABI P = 0.152, TBI P = 0.069). The response to revascularization was less in diabetic patients with a mean tcPO2 increase of 18 mmHg compared to non-diabetic patients with a mean tcPO2 increase of 37 mmHg. TcPO2 measurement appears to be a reliable technique that can influence ischaemic ulcer management.