METABOLIC (TCPO2) AND HEMODYNAMIC DISCORDANCE IN PERIPHERAL VASCULAR EVALUATION OF POSTOPERATIVE STUMP NECROSIS. ABOUT TWO CASES AND LITERATURE REVIEW

Abstract

Objective: Amputation levels are discussed based on hemodynamic approach. Transcutaneous oximetry (TcPO2) is a metabolic test of the local perfusion of peripheral tissues. we report two cases of discordance between hemodynamic and metabolic tests in the evaluation of the level of amputation on stump necrosis. Design and method: study of two cases of amputation level decision using ABI, arterial doppler ultrasound and TcPO2 Results: 1st case: patient A D 52 years old, type 2 diabetic for 11 years, admitted 12 days after amputation of the left forefoot following a complication of the infectious and neuropathic diabetic foot. The clinical examination found an infected necrosis of the amputation stump, the ABI is at 1.22. The arterial Doppler ultrasound objective an atheromatous overload and a good arterial flow. The TcPO2 is 69 mmHg next to the stump, contrasting with a TcPO2 of 27 mmHg on the right. The decision was a necrectomy associated with an antibiotic therapy adapted to the antibiogram. The evolution was favorable. 2nd case: patient S B 71 years old, hypertensive for 20 years, paraplegic for 20 years following a spinal trauma. Hospitalized for management of acute ischemia of the lower limbs on paroxysmal AF. Doppler ultrasound performed in the context of the emergency was in favor of the total occlusion of the regular poplar and leg arteries. Rejected from revascularization, evolution under anticoagulant was marked by the appearance of dry gangrene of both feet. The preoperative evaluation was in favor of a TcPO2 of 41 mmHg on the left and 75 mmHg on the right. An amputation of the two forefeet was performed. The postoperative evolution was characterized by a necrosis of the left stump requiring a complementary gesture with good consequences. Conclusions: The two cases clearly demonstrate the discrepancy between the classic evaluation (anatomical and hemodynamic) and the metabolic evaluation (TcPO2) The TcPO2 provides valuable assistance in deciding the level of amputation regardless of the diabetic, hypertensive, elderly patient profile….and regardless of the vascular profile; normal, PAD, post acute ischemia The TcPO2 is essential before each amputation procedure independently of the hemodynamic evaluation.