CONTRIBUTION OF TRANSCUTANEOUS OXYMETRY IN DIABETIC FOOT SYNDROME
Four major complications are participating in tissue damage in diabetic foot syndrome – diabetic angiopathy, neuropathy, osteoarthropathy and inflammation. Low ankle-brachial pressure index (ABI) is a well-known indicator for ischemia of lower limbs, but in patients with diabetes mellitus is common also a high ABI (over 1.3) as reliable predictor of the presence of arterial calcification – medial calcinosis. Aim of the study is to determine the degree of ischemia using transcutaneous oximetry in patients with diabetic foot syndrome - with clinical manifestations of peripheral arterial occlusive disease (PAOD) and medial calcinosis. We investigated three groups: first consisted of 46 members in IInd stage of PAOD according to Fontaine classification, in second group were 30 members in IIIrd stage of PAOD and third had 29 members in IVth stage of PAOD. The ABI was determined with Doppler ultrasound examination. Transcutaneous oxygen tension (TcPO2) was measured with Oxykapnomonitor Hellige SMK Germany equipment with sensing probe – transoxode. Resting values of TcPO2 were obtained in lying patient on the foot in first metatarsal space. Subsequently leg was passively elevated into 30 degree angle for 3 minutes and then reimposed into primary position. One minute exercise – plantar and dorsal feet flexion was performed and after the TcPO2 values stabilization the patient hung his shin from the edge of the bed touching the floor. TcPO2 values were continuously recorded by analog waveform. In more severe stages of PAOD according to Fontaine stage III and IV we detected lower levels of TcPO2 under basal resting conditions: 20 respectively 5 mmHg. Patients with IInd stage of PAOD had basal TcPO2 values of 40 mmHg. Conclusions of the study are: TcPO2 values are not affected by the presence of medial calcinosis and sothis method is particularly beneficial in patients where Doppler ultrasound examination shows artificial high pressure values on lower limbs. In the third and fourth stage of PAOD passive leg elevation is as effective in determination of ischemia as working test.
Allison, M. A., Hiatt, W. R., Hirsch, A. T., Coll, J. R. & Criqui, M. H. (2008). A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life. Journal of the American College of Cardiology, 51 (13), 1292-1298. ISSN 0735-1097. http://dx.doi.org/10.1016/j.jacc.2007.11.064
Ballard, J. L., Eke, C. C., Bunt, T. J. & Killeen, J. D. (1995). A prospective evaluation of transcutaneous oxygen measurements in the management if diabetic foot problems. Journal of vascular surgery, 22 (4), 485-492. doi: 10.1016/S0741-5214(95)70018-8
Diamantopoulos, E. J., Haritos, D., Yfandi, G., Grigoriadou, M., Margariti, G., Paniara, O. & Raptis, S. A. (1998). Management and outcome of severe diabetic foot infections. Exp Clin Endocrinol Diabetes, 106, 346-352. http://dx.doi.org/10.1055/s-0029-1211996 PMid:9792469
Got, I. (1998). Transcutaneous oxygen pressure (TcPO2): advantages and limitations. Diabetes-Metab, 24, 379-384. PMid:9805653
Hanna, G. P., Fujise, K., Kjelgren, O., Feld S., Fife, C., Schroth, G., Clanton, T., Anderson, V. & Smalling, R. W. (1997). Infrapopliteal transcatheter interventions for limb salvage in diabetic patients, importance of aggressive interventional approach and role of transcutaneous oximetry. Journal of the American College of Cardiology, 30, 664-669. http://dx.doi.org/10.1016/S0735-1097(97)00216-7
McGee, S. & Boyko, E. (1998). Physical examination and chronic lower extremity ischemia: a critical review. Arch Intern Med, 158, 1357-1364. http://dx.doi.org/10.1001/archinte.158.12.1357 PMid:9645831
Meluzínová, H., Weber, P., Navrátilová, Z. & Kubešová, H. (2007). Dekubitus – jak dále v diagnostice, prevenci a léčbe? [Decubitus - how to continue in diagnostics,prevention and treatment?]. Medicína pro praxi [Medicine for practice], 4 (11), 458.
Rathur, H. M. & Boulton, A. J. (2007). The diabetic foot. Clin Dermatol, 25, 109-120. http://dx.doi.org/10.1016/j.clindermatol.2006.09.015 PMid:17276208
Růžička, J., Emmerová, M., Hadravský, M., Krátký, M., Hajšmanová, M. & Patejdlová, M. (2007). Transkutánní oxymetrie [Transcutaneous oximetry]. Pracov Lék, 59, 43-45.
Sadr, S. M., Namayendeh, S. M., Raifiei, M. (2008). Agreement between ABI (ankle brachial index) and USD (ultrasound duplex scanning) in symptomatic peripheral arterial disease patients. The Journal of Tehran University Heart Center, 1, 35-38.
Silvestro, A., Diehm, N., Savolainen, H. Do-Dai, D., Vögele, J., Mahler, F., Zwicky, S. & Baumgartner, I. (2006). Falsely high ankle-brachial index predicts major amputation in critical limb ischemia. Vasc Med, 11, 69-74. http://dx.doi.org/10.1191/1358863x06vm678oa PMid:16886836
Štrbová, L., Krahulec, B., Waczulíková, I., Gaspar, L. & Ambrózy, E. (2009). Charakteristika ulcerácií na nohách diabetikov [Characteristics of ulcerations on feet of diabetics]. Vnitř. Lék., 55, 918-924. PMid:19947234
WHO. (1999). Definition, diagnosis and classification of diabetes mellitus and its complication. Report of consultation - Report 250. WHO, Geneva.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (Creative Commons Attribution License 3.0 - CC BY 3.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
firstname.lastname@example.org, www.iseic.cz, ojs.journals.cz