Skin Blood Flow Measurement With Xenon‐133 to Predict Healing of Lower Extremity Amputations

Abstract

Many techniques have been proposed to help the surgeon select the most distal amputation level that will heal. Skin blood flow measurement with xenon-133 (133Xe) is one of the best documented predictors of amputation healing, but the lowest flow consistent with healing has not been agreed upon. Our early experience with the method is reported. Skin blood flow was measured in 16 patients undergoing 17 lower extremity amputations. Twelve amputations healed (mean skin blood flow 3.69 ? 2.73 m1/100 g of tissue/min) and five failed (mean skin blood flow 0.80 ? 0.61 ml/lOO g of tissuehin) ( P < 0.05). No amputation healed if the skin blood flow was less than 1.0 m1/100 g of tissuehin. A skin blood flow above 1 mVlOO g of tissuelmin, measured with '33Xe, may be a useful guide to the level at which to amputate while minimizing unnecessary proximal amputation, but the method requires further prospective evaluation.

Altered small artery morphology and reactivity in critical limb ischaemia

“…Previous studies have attempted to determine the extent of ischaemia present in the skin at various levels of the leg in patients with CLI. A variety of techniques have been used including radioisotope clearance studies [33,34], laser Doppler flowmetry [35,36] and transcutaneous oximetry (TcPO # ) [37,38]. However, few studies have shown agreement between these methods of assessment of ischaemia and the clinical outcome of the patient.…”

Altered small artery morphology and reactivity in critical limb ischaemia

“…A variety of techniques have been used including radioisotope clearance studies [33,34], laser Doppler flowmetry [35,36] and transcutaneous oximetry (TcPO # ) [37,38]. Previous studies have attempted to determine the extent of ischaemia present in the skin at various levels of the leg in patients with CLI.…”

Selection of amputation level in ischemia: Skin blood flow and perfusion pressure equally predictive

“…Malone et al (1981) found healing in all the cases with skin blood flow over 2.6 mL/100 g tissue/min and healing in half the cases when the flow was between 2 and 2.6 mL. Harris et al (1986) reported healing when skin blood flow was more than 1 mL/100 g tissue/min. However, Holloway and Burgess (1978) were not able to document a clear-cut end point for skin blood flow above which all the amputations healed, and in a more recent investigation Malone et al (1987) found skin blood flow unreliable for selecting the amputation level.…”

“…In several studies, skin blood flow has proved to be of value in selecting the level for amputation (Moore 1973, Harris et al 1986, Malone et al 1981), but there is disagreement concerning the lower limit of skin blood flow. Malone et al (1981) found healing in all the cases with skin blood flow over 2.6 mL/100 g tissue/min and healing in half the cases when the flow was between 2 and 2.6 mL.…”

“…The benefit of peroperative determination of skin blood flow by the Xenon-133 technique (Moore 1973, Malone et al 1981, Harris et al 1986), as well as skin perfusion by the same method (Lassen et al 1974, Holstein et al 1979, Stackel et al 1982, or by the photoelectric method (Holstein 1985, Stackel et al 1982) is well established.…”