Delayed skin oxygenation following distal tibial revascularization (DTR). Implications for wound healing in late amputations.

This article summarizes the authors' experience with prospective transcutaneous oxygen mapping (PtcO2 mm Hg) in patients requiring distal tibial revascularization. Simultaneous measurements were performed measuring preoperatively and early (1-3 days) and late (5-8 days) postoperatively in eight patients undergoing DTR (Group 1) at the chest (CT), below-knee (BK), and midfoot (FT) levels. In an additional 12 patients (Group 2), PtcO2 was measured late postoperatively adjacent to forefoot amputations. PtcO2 measurements were made at room air (RA) and after inhalation of oxygen (O2) in order to evaluate restriction of oxygen delivery. Late postoperative PtcO2 at both BK and FT sites increased (P less than .05) compared to either preop or early postop values. Inhaled O2 increased PtcO2 greatest at the FT late postop time (P less than .001). Group 1 amputations and ischemic ulcers all healed within 4 weeks postoperatively, when PtcO2 values were greater than 25 mm Hg. More extensive amputations required in Group 2 also healed when PtcO2 values exceeded 25 mm Hg, but required a hospitalization period almost three times as long as that of Group 1.