The “gold standard” for amputation level selection: Xenon-133 clearance

Malone, James M.; Leal, Joan; Moore, Wesley S.; Henry, Robert E.; Daly, Michael J.; Patton, Daniel; Childers, Sara Jean

doi:10.1016/0022-4804(81)90089-5

Cited by 46 publications

(9 citation statements)

References 12 publications

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“…Some evidence supports the use of a thigh and/or ankle pressure of 50-70mmHg as a criterion for successful healing after major amputation (Barnes et al., 1976;Dean et al, 1975;Evans et al, 1990;Holstein, 1973;McCollum and Walker, 1992;Pollock et al, 1980;Schwartz et al, 1982), although calcified non-compressible arteries, often found in diabetic patients, give falsely elevated values for thigh and ankle pressures (Gibbons et al, 1979;Raines et al, 1976). Various other tests, such as segmental systolic pressure (Baker et al, 1977;Dean et al, 1975), skin perfusion pressure and/or blood flow (Adera et al, 1995;Dwars et al, 1992;Holloway and Burgess, 1983;Holstein et al, 1979;Karanfilian et al, 1986;Lantsberg and Goldman, 1991;Malone et al, 1981) and TcPo2 (Burgess et al, 1982;Padberg et al, 1996;Wutschert and Bounameaux, 1997;Weiss et al, 1988) have been described as predictors of healing after amputation. Most of these techniques are expensive and difficult to perform correctly, and none has gained wide Factors afecting wound healing 20 1 acceptance Sarin et al, 1991;Wagner et al, 1988).…”

Section: Level Of Amputationmentioning

confidence: 99%

Factors affecting wound healing after major amputation for vascular disease

Eneroth¹

1999

Prosthetics &Amp; Orthotics International

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Section: Level Of Amputationmentioning

confidence: 99%

Factors affecting wound healing after major amputation for vascular disease

Eneroth¹

1999

Prosthetics &Amp; Orthotics International

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“…Skin blood flow and skin perfusion pressure using various nuclear medicine imaging techniques have been reported to provide valuable data for tissue ischemia [9][10][11][12]. However, these methods do not reflect perfusion to deeper tissues and do not indicate the extent or distribution of muscle damage [1].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Muscle Necrosis of Lower Extremities in Peripheral Arterial Disease: The Impact of 99mTc-MDP Scintigraphy on Patient Management

et al. 2019

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Background and objectives: The objective of this study was to assess the value of a whole-body bone scintigraphy using 99m technetium labelled-methyl diphosphonate (99mTc-MDP) for the diagnosis and the assessment of grades of muscle damage after prolonged acute or chronic obstruction of the main arteries in lower extremities. Material and Methods: Fifty consecutive patients were selected for the study. The patients’ condition had not improved after primary peripheral arterial reconstruction operation or limb amputation and after conservative treatment. The clinical suspicion was of arterial obstruction and muscle necrosis. All the patients underwent whole-body scintigraphy with 99mTc-MDP. Muscle necrosis was identified as an increased soft tissue uptake of 99mTc-MDP. Results: Forty-five patients had gross muscle necrosis detected on whole-body scintigraphy with 99mTc-MDP and were histologically confirmed after repeated surgery (necrectomy or amputation) or by muscle biopsy, if only fasciotomy was performed. The location and extent of muscle injury were assessed preoperatively and the findings were confirmed in all 45 patients. Twelve patients with clinically suspected minor muscle damage, which was confirmed as relatively minor muscle necrosis on 99mTc-MDP scintigraphy, were treated conservatively. The clinical outcome of all 50 patients was favorable. The 99mTc-MDP scintigraphy, in detection of muscular necrosis, demonstrated sensitivity, specificity, and accuracy of 97.3% (95% confidence interval (CI) 85.4 to 99.3%), 30.77% (95% confidence interval (CI) 9.09 to 61.43%), and 80% (95% confidence interval (CI) 66.28 to 89.97%), respectively. Conclusion: The 99mTc-MDP scintigraphy is a valuable tool in the detection of muscular necrosis. It is able to define location, extent, and grade of involvement. Therefore, it has a clinical impact in patient management, allowing clinicians to select adequate treatment policy and specify the scope of necrectomy.

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“…The pain scores (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) are shown at Fig 9. At 2 months, pain scores were (0, 0, and 1). Improvement continued post-pump with demarcation of gangrene, improvement of claudication, and improvement of ischemic neuropathy.…”

Section: Human Hyperperfusionmentioning

confidence: 99%

Hypertensive extracorporeal limb perfusion (HELP): A new technique for managing critical lower limb ischemia

Lane

Phillips

McMillan

et al. 2008

Journal of Vascular Surgery

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Blood flow through collaterals can be very significantly augmented by connection to an extracorporeal pump with isolation from the systemic circulation. The pancycle hyperperfusion can be safely repeated by implantation of an arterial access device. In the longer term, there is evidence of collateral development. When amputation is the only alternative, hypertensive extracorporeal limb perfusion should be considered.

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The “gold standard” for amputation level selection: Xenon-133 clearance

Cited by 46 publications

References 12 publications

Factors affecting wound healing after major amputation for vascular disease

Factors affecting wound healing after major amputation for vascular disease

Ischemic Muscle Necrosis of Lower Extremities in Peripheral Arterial Disease: The Impact of 99mTc-MDP Scintigraphy on Patient Management

Hypertensive extracorporeal limb perfusion (HELP): A new technique for managing critical lower limb ischemia

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