Supplemental oxygen and dependent positioning as adjunctive measures to improve forefoot tissue oxygenation

W. C. Johnson, H. I. Grant, D. Baldwin, J. V. Hamilton and J. M. Dion
Department of Surgery, Boston Veterans Administration Medical Center, MA 02130.

Fifty-seven patients with resting pain or tissue necrosis were found to have a forefoot transcutaneous tissue oxygen (tcPO2) level less than 30 mm Hg. The adjunctive measures of foot dependency (36 cm below heart level) and nasal oxygen of 3 L/min were evaluated in these patients. In general, the improvement in tcPO2 levels with these adjunctive measures was not related to basal levels of forefoot or arm tcPO2. One can expect an increase in tcPO2 level of approximately 22 mm Hg while employing the dependent position and an additional benefit of 12 mm Hg with the administration of nasal oxygen. Of the 35 patients with a basal forefoot tcPO2 level of less than 10 mm Hg, 11 did not respond to these adjunctive measures.