Fallibility of doppler ankle pressure in predicting healing of transmetatarsal amputation

Abstract

Sixty transmetatarsal amputations performed in 52 adult male patients for arterial insufficiency were studied to assess reliability of Doppler ankle systolic blood pressure (DABP) measurements in predicting healing. DABP were <-40 mm Hg in four amputations (Group I), 40–60 mm Hg in five amputations (Group II), and >-60 mm Hg in 51 amputations (Group III). Forty-five (75%) of the amputations healed; 50% in Group I, 80% in Group II, and 76% in Group III. DABP for healed amputations was 115 ± 10 mm Hg, while DABP for nonhealed amputations was 96 ± 11 mm Hg and these values were not significantly ( P > 0.05) different. Healing occurred in 5 amputations with dependent rubor confined to the forefoot, while 9 of 12 amputations failed to heal when rubor was present at a higher level. Five of the fifteen nonhealed amputations had cellulitis involving the dorsum of the foot, while only 3 of the 45 healed amputations had similar clinical findings. DABP should not be used as an absolute guide to predict healing of transmetatarsal amputation. Low DABP does not contraindicate transmetatarsal amputation, while higher DABP does not guarantee success. Clinical assessment may be used reliably to predict healing.