| 7 |
Clinical Research
|
Transcutaneuos oximeter measurements: predicting outcomes in advanced wound healing Brian Solomon, BSc, Caesar Anderson, MD, Lisa Corbet, APRN, CWOCN, CWS, John Montminy, DO, Bettina Magliato, RN, George Perdrizet, MD, PhD, FACS, CWS INTRODUCTION: .Transcutaneous oxygen monitoring (TCOM) is the test used to determine the oxygen tension in the skin measured in millimeters of Hg (TcPO2). It is an invaluable tool for predicting potential candidates for hyperbaric oxygen therapy (HBO2T). In 1994, Matos and Nunez reviewed a series of tissue oxygenation studies and concluded that TcPO2 was clinically useful in determining healing potential, selecting amputation level, evaluating revascularization procedures, and assessing severity and progression of peripheral vascular disease. Values > 40 mmHg were associated with good healing, 20-40 mmHg with intermediate healing, and < 20 mmHg with poor healing. We have performed a retrospective review of wound patients receiving TcPO2 measurements in order to assess its efficacy and predictability in determining therapeutic outcome. METHODS: .A retrospective review of 54 Hartford Hospital Wound Center patients was conducted. Each patient's wound outcome was analyzed with respect to their TCOM values, medical comorbidity, and vascular status RESULTS: .TCOM data reviewed were supportive of clinical healing rates. Adequate TCOM values were associated with 89% clinical response. A greater proportion of wound patients with TcPO2 values > 40 mmHg were able to avoid amputation and achieve adequate healing compared to patients with values <20 mmHg. Predictive values were similar for both ABI (Ankle Brachial Index) and TCOM measurements. Patients with inadequate initial TCOM values had increased rates of response when treated with HBO2 (Hyperbaric effect) CONCLUSION: .It appears that transcutaneous oxygen tension measurements is a useful predictor in defining the level of suspected tissue hypoxia. However, multiple medical factors contribute to the overall patient which may obscure the efficacy in predicting patient therapeutic outcome. Moreover, our data supports TcPO2 measurement as a useful adjunct for assessing improved tissue perfusion/oxygen delivery and as an invaluable tool in management of problem wounds. Zgonis T, Garbalosa JC, Burns P, Vidt L, Lowery C. A retrospective study of patients with diabetes mellitus after partial foot amputation and hyperbaric oxygen treatment. J Foot Ankle Surg. 2005;44(4):276Ð280.. .Fife CE, Buyukcakir C, Otto GH, et al. The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy: a retrospective analysis of 1,144 patients. Wound Rep Regen. 2002;10(4):198Ð207. Thomas PS, Hakim TS, Trang LQ, Hosain SI, Camporesi EM. The synergistic effect of sympathectomy and hyperbaric oxygen exposure on transcutaneous PO2 in healthy volunteers. Anesth Analgesia. 1999;88(1):67Ð71. Ratzenhofer-Komenda B, Kovac H, Smolle-Juttner FM, Friehs GB, Schwarz G. Quantification of the dermal vascular response to hyperbaric oxygen with laser-Doppler flowmetry. Undersea Hyperbaric Med. 1998;25(4):223Ð227. . .Williams RL, Armstrong DG. Wound healing. New modalities for a new millennium. Clin Podiatr Med Surg. 1998;15(1):117Ð128. . .Omae T, Ibayashi S, Kusuda K, Nakamura H, Yagi H, Fujishima M. Effects of high atmospheric pressure and oxygen on middle cerebral blood flow velocity in humans measured by transcranial Doppler. Stroke. 1998;29(1):94Ð97. . .Carnochan FM, Abbot NC, Beck JS, Spence VA, James PB. The influence of histamine and PGE2-induced hyperaemia and oedema on respiratory metabolism in normal human forearm skin. Agents Actions. 1990;29(3-4):292Ð298. . .Wattel F, Mathieu D, Coget JM, Billard V. Hyperbaric oxygen therapy in chronic vascular wound management. Angiol. 1990;41(1):59Ð65. . .Huch A, Huch R, Hollmann G, et al. Transcutaneous pO2 of volunteers during hyperbaric oxygenation. Biotelemetry. 1977;4(2):88Ð100. Matos L, Nunez A. Enhancement of healing in select problem lwounds. Hyperbaric Med Pract. 1994;(12):589Ð586. |
|