G. S. De Silva1, K. Saffaf1, L. A. Sanchez1, M. A. Zayed1,2 1Washington University In St. Louis,Department Of General Surgery/Division Of Vascular Surgery,St. Louis, MISSOURI, USA 2Veterans Affairs St. Louis Health Care System,St. Louis, MISSOURI, USA
Introduction: More than 130,000 extremity amputations are performed in the U.S. per year. In 40% of patients, poor amputation site healing requires stump revision and/or re-amputation. This contributes to added patient morbidity, disability, and healthcare costs. We hypothesize that inadequate tissue perfusion is associated with poor amputation stump healing. We evaluated this using non-invasive Laser-Assisted Fluorescent Angiography (LAFA; SPY Elite® system) in the peri-operative setting.
Materials and
Methods: A pilot group of ‘higher-risk’ patients were evaluated prospectively at the time of major lower extremity amputation. Immediately following stump creation, LAFA was intra-operatively performed. Rate of arterial inflow and peak perfusion were determined using densitometry analysis. Post-operative stump healing was serially evaluated for 4-6 weeks using a modified Bates-Jensen Wound Assessment Tool. Non-parametric Spearman correlation analysis was performed to evaluate stump perfusion and healing variables.
Results: In a cohort of 8 patients (100% smoking, 75% diabetic), the least globally well-perfused stumps had the highest necrotic eschar scores (p=0.04), as well as increased volume of eschar (p=0.05). Similarly, amputation stumps with lower perfusion scores just along the surgical suture line were more likely to also develop a necrotic eschar (R2=0.834, p<0.05), and increased eschar volume (R2=0.842, p<0.05). We observed no correlation between low stump perfusion scores and higher iliac and common femoral arterial runoff scores (major arterial occlusions).
Conclusions: In ‘higher-risk’ patients, peri-operative perfusion assessments of amputation stumps using LAFA can help predict potential areas of necrotic eschar formation. Intra-operative determination of areas of decreased amputation stump perfusion may encourage corrective intervention or anticipate subsequent wound care needs.
