Abstract
Currently, transcutaneous oxygen tension measurement (TCpO2) is the most favorable non-invasive test for diabetic foot ulcer (DFU) healing prognosis. Photo-optical TCpO2 is novel, less time-consuming and more practical in use compared to regular electro-chemical TCpO2. We prospectively investigated the clinical value of photo-optical TCpO2 to predict DFU healing. Patients with suspected DFU undergoing conservative treatment underwent an ankle pressure, toe-pressure and photo-optical TCpO2 test. The primary endpoint was DFU wound healing at 12 months. Based on their clinical outcome, patients were divided into a DFU healing and DFU non-healing group. Healing was defined as fully healed ulcers and non-healing as ulcers that deteriorated under conservative treatment or that required surgical amputation. Differences between groups were analyzed and an optimal TCpO2 cut-off value was determined. In total, 103 patients were included, of which 68 patients (66%) were classified as DFU healing. The remaining 35 patients (34%) had deteriorated ulcers, of which 29 (83%) eventually required surgical amputation. An optimal TCpO2 cut-off value of 43 mmHg provided a sensitivity, specificity and odds ratio of 0.78, 0.56 and 4.4, respectively. Photo-optical TCpO2 is an adequate alternative tool to validate the vascular status of the lower extremity indicating healing prognosis in patients with DFU. Therefore, we recommend that photo-optical TCpO2 can be safely coapplied in clinical practice to assist in DFU treatment strategy.
Highlights
The diabetic foot ulcer (DFU) is a devastating result of poor glycemic control, peripheral neuropathy, peripheral vascular disease and immunosuppression in patients with diabetes mellitus [1,2]
It is estimated that one in every six DFUs result in lower limb amputation, causing DFUs to account for approximately 85% of all lower limb amputations [3,4]
Half of the patients with DFU suffer from concomitant peripheral arterial disease (PAD), significantly lowering the chance of DFU healing compared to patients without PAD [5,6]
Summary
The diabetic foot ulcer (DFU) is a devastating result of poor glycemic control, peripheral neuropathy, peripheral vascular disease and immunosuppression in patients with diabetes mellitus [1,2]. Detection of underlying PAD in patients with DFU is crucial and an essential marker for DFU healing prognosis [7]. Transcutaneous oxygen tension measurement (TCpO2) is advocated as the best available non-invasive test to predict DFU healing [7]. Oxygen molecules reflect light at a specific wavelength when they absorb light and undergo a phase shift. By capturing this emitted light from the oxygen molecule, the partial oxygen pressure can be derived [11]. The added value of photo-optical TCpO2 for DFU healing in clinical practice, has not been established. The purpose of this study was to evaluate the added value of DFUs healing prediction with photo-optical TCpO2
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