Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study

Zetzmann K, Papatheodorou N, Rühl E, Yagshyyev S, Haney B, Moosmann O, Li Y, Meyer A, Knieling F, Behrendt CA, Lang W, Rother U (2024)

Publication Type: Journal article

Publication year: 2024

Journal

SAGE Open Medicine Sage Publications

Book Volume: 12

DOI: 10.1177/20503121241263244

Abstract

Introduction: Although major amputations can often be avoided due to evolving methods of endovascular and surgical revascularizations techniques, in patients with chronic limb-threatening ischemia, it is still necessary in some cases. Aim of this study was the detection of wound healing disorders through intraoperative microcirculation measurements in major limb amputations. Materials and methods: In this single-center clinical study, patients with an indication for major amputation were enrolled prospectively. Cause of amputation, patients’ comorbidities including cardiovascular risk profile were assessed. Macrocirculation, as well as microcirculation were assessed. Microcirculation measurements were performed by fluorescence angiography with the administration of indocyanine green. A preoperative measurement was obtained at the amputation level, followed by three additional measurements of the amputation stump postoperatively. Wound healing was monitored and correlated with the microcirculatory findings, based on the perfusion parameters ingress and ingress rate, calculated in the indocyanine green fluorescence video sequences of the amputation stumps. Results: Forty-five patients were enrolled, including 19 (42%) below-the-knee amputations and 26 (58%) above-the-knee amputations. When considering the need for revision, a change in the microperfusion parameters was observed postoperatively. The mean value for ingress was significantly lower directly postoperatively in stumps requiring revisions (5 ± 0 A.U. versus 40.5 ± 42.5 A.U., p < 0.001). The mean value of ingress rate behaved similarly (0.15 ± 0.07 A.U./s versus 2.8 ± 5.0 A.U./s, p = 0.005). The evaluation of indocyanine green measurements when wound healing disorders occurred also showed nonsignificant differences in the mean values. Conclusion: Fluorescence angiography after major lower limb amputations appears to be an option of depicting microperfusion. Especially, the early postoperative detection of reduced perfusion can indicate a subsequent need for revision. Therefore, this method could possibly serve as a tool for intraoperative quality control after major limb amputation.

Authors with CRIS profile

Katharina Zetzmann Department of Vascular Surgery Nikolaos Papatheodorou Department of Vascular Surgery Eva Rühl Medizinische Fakultät Shatlyk Yagshyyev Department of Vascular Surgery Briain Haney Department of Vascular Surgery Oxana Moosmann Department of Vascular Surgery Yi Li Department of Vascular Surgery Ferdinand Knieling Department of Paediatrics and Adolescent Medicine Werner Lang Department of Vascular Surgery Ulrich Rother Department of Vascular Surgery

Involved external institutions

HELIOS Kliniken DE Germany (DE) Asklepios Kliniken DE Germany (DE)

How to cite

APA:

Zetzmann, K., Papatheodorou, N., Rühl, E., Yagshyyev, S., Haney, B., Moosmann, O.,... Rother, U. (2024). Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study. SAGE Open Medicine, 12. https://doi.org/10.1177/20503121241263244

MLA:

Zetzmann, Katharina, et al. "Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study." SAGE Open Medicine 12 (2024).

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