0
Articles   |    
Results of amputation for gangrene in diabetic and non-diabetic patients. Selection of amputation level using photoelectric measurements of skin-perfusion pressure
KS Christensen; N Falstie-Jensen; ES Christensen; J Brochner-Mortensen
J Bone Joint Surg Am, 1988 Dec 01;70(10):1514-1519
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Evaluation was done of 235 patients who had had 273 primary amputations for gangrene. Measurements of local skin-perfusion pressure or systolic blood pressure were made in 222 limbs (188 patients). For the other fifty-one limbs, for which no measurements of pressure were available, the surgeon elected to perform an above-the-knee amputation in nine of seventeen diabetic limbs and a below-the-knee amputation in eight. An above-the-knee amputation was selected by the surgeon for thirty-two of thirty-four non-diabetic limbs and a below-the-knee amputation, for two for which no measurements of pressure were available. Local skin-perfusion pressure was measured distal to the knee before amputation, using a standardized photoelectric technique in 203 limbs and systolic blood-pressure measurements in nineteen. Skin-perfusion pressure was also measured above the knee in seventy-six of the 222 limbs in which a pressure was determined below the knee. These measurements were made available to the surgeon for use as an adjuvant guide to clinical assessment in selecting the appropriate level of amputation. Seventy-four patients (ninety-two amputations) had diabetes and 114 patients (130 amputations) did not. The limbs of the diabetic patients had a significantly higher skin-perfusion pressure at the below-the-knee level (p less than 0.001) than did those of the non-diabetic patients. The ratios of below-the-knee to above-the-knee amputations for the diabetic and non-diabetic patients were 3.8 to one and 1.3 to one (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Figures in this Article
    This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/27/2014
    MA - Boston Medical Center and Boston University School of Medicine
    11/15/2013
    LA - Ochsner Health System
    12/04/2013
    NY - Icahn School of Medicine at Mount Sinai