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A Criterion for Healing of Below-Knee Amputation

Steven J. Burnham, MD; Willis H. Wagner, MD; Blair A. Keagy, MD; George Johnson, Jr, MD

Arch Surg. 1990;125(1):104-106.

Abstract
• Quantitative fluorometry has been recommended as an accurate adjunct to clinical judgment in the preoperative assessment of lower-extremity amputation level. In this prospective study of 56 patients who had below-knee amputation, clinical judgment was used as the sole criterion for site selection. Quantitative fluorometry was compared with clinical judgment in a prospective, blinded study. All patients were studied before amputation with administration of intravenous fluorescein. Fifteen minutes after injection, objective measurement of dye fluorescence was performed at multiple sites with a quantitative fluorometer, and a dye fluorescence index was derived. All limbs undergoing amputation were ischemic, manifested by rest pain, nonhealing ulcers, or gangrene. Five patients (8.7%) failed to heal at the below-knee level. The mean dye fluorescence index for the group that healed was 81±51 (range, 13 to 259) and for the group that failed to heal, 110±49 (range, 70 to 195). Objective measurement of fluorescein perfusion did not correlate with amputation healing at the below-knee level in our patient population.

(Arch Surg. 1990;125:104-106)

Author Affiliations
From the Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill.

Footnotes
Accepted for publication August 12, 1989.

Reprint requests to 210 Burnett-Womack Building, Box 7050, Chapel Hill, NC 27599-7050 (Dr Burnham).

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