Evaluation of skin perfusion pressure to assess refractory foot ulcers

Background Diabetic foot ulcers combined with ischemia and infection can be difficult to treat. Few studies have quantified the level of blood supply and infection control required to treat such complex diabetic foot ulcers. We aimed to propose an index for ischemia and infection control in diabetic chronic limb-threatening ischemia (CLTI) with forefoot osteomyelitis. Methods We retrospectively evaluated 30 patients with diabetic CLTI combined with forefoot osteomyelitis who were treated surgically from January 2009 to December 2016. After 44 surgeries, we compared patient background (age, sex, hemodialysis), infection status (preoperative and 1- and 2-week postoperative C-reactive protein [CRP] levels), surgical bone margin (with or without osteomyelitis), vascular supply (skin perfusion pressure), ulcer size (wound grade 0–3 using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification), and time to wound healing between patients with healing ulcers and those with nonhealing ulcers. Results Preoperative CRP levels and the ratio of ulcers classified as wound grade 3 were significantly lower and skin perfusion pressure was significantly higher in the healing group than in the nonhealing group (P < .05). No other significant differences were found between groups. Conclusions This study demonstrates that debridement should be performed first to control infection if the preoperative CRP level is greater than 40 mg/L. Skin perfusion pressure of 55 mm Hg is strongly associated with successful treatment. We believe that this research could improve the likelihood of salvaging limbs in patients with diabetes with CLTI.

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Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery

The Journal of Vascular Access ◽

10.1177/1129729821993985 ◽

2021 ◽

pp. 112972982199398

Author(s):

Miju Bae ◽

Sung Woon Chung ◽

Chung Won Lee ◽

Up Huh ◽

Moran Jin ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Sensitivity And Specificity ◽

Brachial Artery ◽

Perfusion Pressure ◽

Characteristic Curve ◽

Major Complication ◽

Clinical Predictors ◽

Skin Perfusion ◽

Hand Ischemia ◽

Skin Perfusion Pressure

Background: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery. Methods: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined. Results: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient ( p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI ( p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively. Conclusion: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.

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Changes in the observed variable of skin perfusion pressure (SPP) testing in correlation with the progression of arteriosclerosis

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.45.1141 ◽

2012 ◽

Vol 45 (12) ◽

pp. 1141-1146

Author(s):

Michiaki Hara

Keyword(s):

Perfusion Pressure ◽

Skin Perfusion ◽

Skin Perfusion Pressure

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Skin perfusion pressure and healing after below-the-knee amputation

Italian Journal of Vascular and Endovascular Surgery ◽

10.23736/s1824-4777.17.01296-7 ◽

2017 ◽

Vol 24 (3) ◽

Author(s):

Kate Smidt ◽

Jan Abrahamsen ◽

Niels H. Krarup ◽

Thomas Jakobsen

Keyword(s):

Perfusion Pressure ◽

Skin Perfusion ◽

Knee Amputation ◽

Below The Knee ◽

Skin Perfusion Pressure

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Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure

Prosthetics and Orthotics International ◽

10.3109/03093648009164568 ◽

1980 ◽

Vol 4 (2) ◽

pp. 81-86 ◽

Cited By ~ 8

Author(s):

P. Holstein

Keyword(s):

Complication Rate ◽

Perfusion Pressure ◽

Wound Complication ◽

External Pressure ◽

Wound Complications ◽

Local Skin ◽

Skin Perfusion ◽

Skin Perfusion Pressure ◽

The Difference

Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured pre-operatively as the external pressure required to stop isotope washout using 131I-- or 125I--anti-pyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no fewer than 9 (82 per cent) suffered wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only 4 cases (8 per cent). The difference in wound complication rate is highly significant (P<0.01). It is concluded that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

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Measurement of Skin Perfusion Pressure in Hemodialyzed Patients: Association with Toe/Brachial Index

Dialysis & Transplantation ◽

10.1002/dat.20281 ◽

2008 ◽

Vol 37 (11) ◽

pp. 431-438 ◽

Cited By ~ 1

Author(s):

Masaru Shimazaki ◽

Takayuki Matsuki ◽

Kazuaki Yamauchi ◽

Michihiro Iwata ◽

Hiroshi Takahashi ◽

...

Keyword(s):

Perfusion Pressure ◽

Skin Perfusion ◽

Skin Perfusion Pressure ◽

Toe Brachial Index

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Low plantar skin perfusion pressure predicts long-term atherosclerotic vascular events and mortality in maintenance haemodialysis patients

Atherosclerosis ◽

10.1016/j.atherosclerosis.2020.09.006 ◽

2020 ◽

Vol 312 ◽

pp. 66-71

Author(s):

Maki Hiratsuka ◽

Katsushi Koyama ◽

Hiroshi Takahashi ◽

Takahisa Kasugai ◽

Junichiro Hagita ◽

...

Keyword(s):

Perfusion Pressure ◽

Vascular Events ◽

Skin Perfusion ◽

Maintenance Haemodialysis ◽

Skin Perfusion Pressure

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Changes in Skin Perfusion Pressure After Endovascular Treatment for Chronic Limb-Threatening Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602820963932 ◽

2020 ◽

pp. 152660282096393

Author(s):

Shigeo Ichihashi ◽

Mitsuyoshi Takahara ◽

Naoki Fujimura ◽

Tsuyoshi Shibata ◽

Miki Fujii ◽

...

Keyword(s):

Endovascular Treatment ◽

Perfusion Pressure ◽

Peroneal Artery ◽

Prospective Multicenter Study ◽

Skin Perfusion ◽

Posterior Tibial ◽

Tibial Arteries ◽

Skin Perfusion Pressure ◽

Indirect Revascularization ◽

Preoperative Factors

Purpose To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes. Materials and Methods This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively. Results Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change. Conclusion The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

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