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Logo for the Journal of Rehab R&D
Volume 43 Number 7, November/December 2006
Pages 891 — 904


Abstract - Preamputation evaluation of limb perfusion with laser Doppler imaging and transcutaneous gases

Stephen F. Figoni, PhD, RKT;1 Oscar U. Scremin, MD, PhD;2-3* Charles F. Kunkel, MD, MS;1,4
Dorene Opava-Rutter, MD;1 Jessica Johnson, PT;1 Eric D. Schmitter, MD;5-6 A. M. Erika Scremin, MD1,4

Departments of 1Physical Medicine and Rehabilitation and 2Research, Department of Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), Los Angeles, CA; Departments of 3Physiology and 4Medicine, David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, CA; 5Department of Surgery, VAGLAHS, Los Angeles, CA; 6Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
Abstract — We studied 31 subjects with severe leg ischemia and 29 age-matched nonischemic control subjects to compare preamputation assessments of leg ischemia using laser Doppler imaging (LDI), transcutaneous partial pressure of oxygen (TcPO2), and transcutaneous partial pressure of carbon dioxide (TcPCO2). TcPO2 and TcPCO2 were evaluated with Novametrix Medical Systems, Inc, monitors (Wallingford, Connecticut) and perfusion (flux) of skin topically heated to 44 C, and adjacent nonheated areas were evaluated with a Moor Laser Doppler Imager (Moor Instruments, Ltd; Devon, England). LDI flux of heated areas, its ratio to nonheated areas, and TcPO2 (not TcPCO2) were lower in ischemic subjects than in control subjects. LDI flux ratio performed better than TcPO2 in identifying ischemia, with fewer false positive and false negative results. Moreover, LDI flux of heated skin detected a proximal to a distal gradient of perfusion in ischemic subjects, while TcPO2 did not. LDI was superior to TcPO2 in discriminating correctly between ischemic and nonischemic skin. The results suggest that an LDI ratio below 5 indicates nonviable skin.
Key words: amputation, blood gas monitoring, ischemia, laser Doppler flowmetry, leg, oxygen, perfusion, peripheral vascular diseases, rehabilitation, transcutaneous.

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