Transcutaneous oxygen tension and toe blood pressure as predictors for outcome of diabetic foot ulcers.

Kalani, Majid; Brismar, Kerstin; Fagrell, B; Östergren, Jan; Jörneskog, Gun

doi:10.2337/diacare.22.1.147

Cited by 250 publications

(210 citation statements)

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“…TcPO 2 , being a composite measure of several factors such as arterial pressure, arterial oxygen content, local tissue perfusion pressures, neurovascular function and local oxygen consumption, may be a more relevant measure, as it seems to reflect micro-as well as macrocirculation. TcPO 2 has previously been shown to be related to outcome in diabetic foot ulcers [7]. Case series indicate that TcPO 2 might be a predictor for healing after HBOT, but large comparative studies are still lacking.…”

Section: Discussionmentioning

confidence: 99%

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

et al. 2010

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Aims/hypothesis The randomised, double-blind, placebocontrolled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. Methods All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n=75). Baseline transcutaneous oximetry (TcPO 2 ), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up. ResultsIn the HBOT group TcPO 2 were significantly lower for patients whose ulcer did not heal as compared with those whose ulcers healed. A significantly increased healing frequency was seen with increasing TcPO 2 levels in the HBOT group (TcPO 2 /healing rate: <25 mmHg/0%; 26-50 mmHg/50%; 51-75 mmHg/73%; and >75 mmHg/ 100%). No statistically significant relation between the level of TBP or ABI and healing frequency was seen. Conclusions/interpretation Our results indicate that TcPO 2 in contrast to ABI and TBP correlates to ulcer healing following HBOT. We suggest HBOT as a feasible adjunctive treatment modality in diabetic patients with chronic non-healing foot ulcers when basal TcPO 2 at the dorsum of the foot is above 25 mmHg. Trial registration NCT00953186 Funding Mrs

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Section: Discussionmentioning

confidence: 99%

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

et al. 2010

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“…TcPO 2 measurements were performed at the dorsum of the foot, with the patients initially in a supine and then in a sitting position with their legs hanging down for postural provocation. The reference value was determined by placing the probe on the right side of the chest in the suclavian region and calculating the regional perfusion index (16). To further exclude peripheral vascular disease or mediasclerosis as potential sources of error, the ankle pressures were measured with a 10-cm-wide pneumatic cuff and a Doppler flow probe (Huntleigh Diagnostics, Cardiff, U.K.).…”

Section: Skin Blood Flow Determinationmentioning

confidence: 99%

Early Detection of Microcirculatory Impairment in Diabetic Patients With Foot at Risk

et al. 2001

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OBJECTIVE -To assess microcirculatory impairment and alterations of the skin oxygen supply in diabetic patients with foot at risk.RESEARCH DESIGN AND METHODS -This study evaluated skin blood flow in 21 type 2 diabetic patients with a foot at risk (defined as a foot with neuropathy but without ulceration or previous ulcerations), 20 type 2 diabetic patients without foot lesions or neuropathy, and 21 normal subjects as a control group. The skin blood flow was determined by measuring the transcutaneous oxygen pressure (TcPO 2 ) at the dorsum of the foot in supine and sitting position. The clinical assessment included standard measures of peripheral and autonomic neuropathy, but peripheral vascular disease was excluded by Doppler ultrasound.RESULTS -In supine position, TcPO 2 was significantly reduced (means Ϯ SE) in diabetic patients with foot at risk (6.04 Ϯ 0.52 kPa) compared with diabetic (7.14 Ϯ 0.43 kPa, P ϭ 0.035) and nondiabetic (8.10 Ϯ 0.44 kPa, P ϭ 0.01) control subjects. The sitting/supine TcPO 2 difference was higher in diabetic subjects with foot at risk (3.13 Ϯ 0.27 kPa) compared with both diabetic (2.00 Ϯ 0.18, P ϭ 0.004) and nondiabetic (1.77 Ϯ 0.15 kPa, P ϭ 0.0003) control subjects. The mean sitting/supine ratio was 1.70 Ϯ 0.12 in diabetic patients with foot at risk, 1.32 Ϯ 0.04 in diabetic control subjects, and 1.25 Ϯ 0.03 in nondiabetic control subjects (P ϭ 0.007). The sitting/supine TcPO 2 ratio was negatively correlated with the heart rate variation coefficient at rest (r ϭ Ϫ0.32, P ϭ 0.044) and at deep respiration (r ϭ Ϫ0.31, P ϭ 0.046).CONCLUSIONS -Our data indicate that skin oxygen supply is reduced in type 2 diabetic patients with foot at risk. This is probably due to an impaired neurogenic blood flow regulation and may contribute to capillary hypertension, followed by disturbed endothelial function leading to edema and skin damage of the foot. The determination of TcPO 2 appears to be a useful tool in screening type 2 diabetic patients for foot at risk. Diabetes Care 24:1810 -1814, 2001F oot ulcerations in diabetic patients are a major health problem, often leading to lower-limb amputations and an increased death rate (1,2). The management of diabetic foot ulcers creates considerable costs, estimated at about $1.5 billion in the U.S. Medicare system in 1995 (3). Diabetic neuropathy, mechanical stress, and blood flow alterations are involved in the pathogenesis of diabetic foot ulceration (4,5). These factors interact with the microcirculation, resulting in the failure of skin capillary blood flow (5-9). Besides other factors, reduced skin oxygenation and both sensory and autonomic neuropathy increase the risk of foot ulceration, and screening for and detection of these factors may be useful (5,10). The autonomic nervous system, which supplies sympathetic adrenergic fibers to the arterioles and arteriovenous shunts, directly influences peripheral circulation (8,11). As shown in several studies, transcutaneous oxygen pressure (TcPO 2 ) measurement provides useful information about microcircu...

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“…The healing prediction index exhibited a sensitivity and specificity of 80 and 74%, respectively. 31 Alternatively, Kalani et al 54 measured the transcutaneous oxygen tension (TcPO 2 ) on the feet of 50 type 1 and 2 diabetes patients with existing diabetic foot ulcers. They showed that the ulcers on the feet of patients with TcPO 2 greater than 25 mm Hg healed within 4-6 weeks while ulcers on the feet of patients with TcPO 2 lower than 25 mmHg did not heal.…”

mentioning

confidence: 99%

“…The sensitivity and specificity of the ulcer healing prediction index obtained using hyperspectral imaging 31,32 were lower than those reported for TcPO 2 . 54 However, hyperspectral imaging is noninvasive and can assess oxygen saturation with high spatial resolution in a relatively short time. On the contrary, TcPO 2 requires (1) physical contact between the foot and a probe, (2) can only measure the average tissue oxygen content over an entire limb, and (3) may take up to 20 minutes to produce a reading.…”

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confidence: 99%

Hyperspectral Imaging in Diabetic Foot Wound Care

Yudovsky

Nouvong

Pilon

2010

J Diabetes Sci Technol

140

109

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Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers could inform the diabetes caregiver about the severity of the wound and help assess the need for amputation. This article reviews how hyperspectral imaging between 450 and 700 nm can be used to assess the risk of diabetic foot ulcer development and to predict the likelihood of healing noninvasively. Two methods are described to analyze the in vivo hyperspectral measurements. The first method is based on the modified Beer-Lambert law and produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the dermis of the foot. The second is based on a two-layer optical model of skin and can retrieve not only oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration along with skin scattering properties. It can detect changes in the diabetic foot and help predict and understand ulceration mechanisms

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Transcutaneous oxygen tension and toe blood pressure as predictors for outcome of diabetic foot ulcers.

Abstract: The results indicate that TcPO2 is a better predictor for ulcer healing than TBP in diabetic patients with chronic foot ulcers, and that the probability of ulcer healing is low when TcPO2 is < 25 mmHg.

Cited by 250 publications

References 0 publications

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

Early Detection of Microcirculatory Impairment in Diabetic Patients With Foot at Risk

Hyperspectral Imaging in Diabetic Foot Wound Care

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