Predicting success of forefoot amputations in diabetics by noninvasive testing
G. W. Gibbons, F. C. Wheelock Jr, C. S. Hoar Jr, J. L. Rowbotham and C. Siembieda
Sixty-six diabetic patients underwent needed forefoot amputations when
clinical assessment indicated a reasonable chance of healing. All patients
underwent noninvasive testing consisting of segmental systolic pressure
measurements and pulse volume recordings (PVRs) taken at the thigh, calf,
ankle, and forefoot levels. Segmental systolic pressures were falsely high
(greater than 200 mm Hg) and therefore not useful in 56%. Ankle systolic
pressures predicted failure in 36% of patients who healed and success in
64% who failed to heal. Segmental PVRs were sequentially predictive in only
50%. Forefoot PVR traces predicted failure in 50% of patients whose
amputations healed. No patient should be denied a forefoot amputation
solely on the basis of unfavorable results of noninvasive tests. Favorable
clinical signs and a strongly positive forefoot PVR trace are the best
predictors of successful forefoot amputations in diabetic patients.
