Valor pronóstico de la TcPO2 en la cicatrización de lesiones en pie diabético tras revascularización

Abstract

IntroductionThe measurement of transcutaneous oxygen pressure (TcPO2) is a useful tool in non-invasive vascular diagnosis, as well as being a valuable prognostic test of vascular ulcer healing before and after revascularization. ObjectiveThe aim of this study was to determine the most reliable TtPO2 cut—off value for predicting healing, as well as to find out if the increase in the TcPO2 after revascularization can be predictor of a good outcome after this intervention in diabetic patients with ischemic ulcers. Material and methodsA retrospective study was performed using the prospectively maintained data base of the Diabetic Foot Unit of the Hospital Universitario Fundación de Alcorcón. Diabetic patients with ulceration and critical ischemia criteria were included, particularly those that had TcPO2 performed before and after revascularization, successful wound healing and time to healing. ResultsA total of 18 patients were found, of whom 72% were males and 28% females. The mean age was 68 years, with 94.7% hypertension, 73.7% dyslipidemia, and 63.2% retinopathy. A total of 19 revascularizations were performed, of which 13 were endovascular, 4 bypass, and 2 hybrid procedures. The ankle-brachial index was not assessable in 68%. A healing rate of 53% and a median time to healing of 103 days were obtained. The mean preoperative TcPO2 values in healed and non-healed was 14.6±9.40 and 18.6±12.93mmHg, respectively (P=.4404). The mean postoperative levels of TcPO2 were 40.8±10.85mmHg in healed and 23.5±13.27mmHg in non-healed (P=.0063). Using ROC curve analysis, it was determined that TcPO2 levels equal to or greater than 35mmHg were indicators of a good prognosis for wound healing. An increase in the TcPO2 above 15mmHg is a factor of a good prognosis after revascularization of diabetic foot. ConclusionsTcPO2 is a useful tool for determining the prognostic value in wound healing in the diabetic patient with critical ischemia, particularly in patients with non-assessable partial pressures. The cut-off for a good prognosis of wound healing, according to this study, is equal to or greater than 35mmHg. An increase in the TcPO2 above 15mmHg from the baseline value is also a factor of a good prognosis after revascularization.