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Clinical Research
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Intermittent pneumatic compression of the calf improves the outcome of lower extremity amputations in the high-risk foot S.J Kavros, N.S. Turner, A.E. Voll, D.A. Liedl, K.T. Delis, T.W. Rooke Background.The objective of this study was to compare the outcomes of surgical intervention with amputation in the high-risk foot with the use of an intermittent pneumatic compression pump. All individuals had non-healing foot wounds with tissue loss in the setting of severe to chronic critical limb ischemia. Many patients had previous revascularization procedures (79%) prior to developing these challenging wounds Methods.The setting was a community orthopedic, vascular surgical and a multidisciplinary wound healing clinic. There were two groups of patients; each group had 24 individuals enrolled for this clinical study. One group used an intermittent pneumatic compression pump (IPC) prior to and after a partial foot amputation (toe, metatarsal of forefoot) while the other group did not. Patient assessments included ankle brachial indices (ABI), transcutaneous oximetry (TcPO2), prior arterial reconstruction, ultrasound graft surveillance and radiographs. Surgical outcomes were considered positive if complete healing occurred and limb salvage was maintained. An unacceptable outcome was noted if the patient proceeded to a below knee amputation after the local amputation failed. Patients were followed for 18 months Results.In the control group (no IPC utilized), 4 (17%) of the patients had complete healing and limb salvage. Twenty (20) patients (83%) failed a local foot amputation and proceeded to BKA. In the group that used the IPC, 14 (58%) of the patients had complete healing after a local foot amputation. Ten (10) patients (42%) advanced to a BKA after failure of a local foot amputation Conclusion .Patients with severe and chronic critical limb ischemia may benefit from the use of an intermittent pneumatic compression pump as adjunctive therapy when considering a local foot amputation. The use of the IPC pump appears beneficial in the treatment algorithm of a local foot amputation and reduces the occurrence of a non-traumatic below knee amputation. Montori VM, Kavros SJ, Walsh EE, Rooke TW. Intermittent compression pump for nonhealing wound in patients with limb ischemia. The Mayo Clinic experience (1998 Ð 2000). Int Angiol 2002;21:360Ð366 Delis KT, Knaggs AL. Duration and amplitude decay of acute arterial leg inflow enhansement with intermittent pneumatic leg comptression: an insight ino the implicated physiologic menchanisms. J Vasc Surg 2005;42(4):717Ð725..Pfizenmaier DH, Kavros SJ, Liedl DA, Cooper LT. Use of intermittent pneumatic compression for treatment of upper extremity vascular ulcers. Angiol. 2005;56(4):417Ð422 .. |
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