Can Macrocirculation Changes Predict Nonhealing Diabetic Foot Ulcers?

Abstract

PURPOSE: Transcutaneous partial oxygen tension (TcpO(2)) is considered the gold standard for assessment of tissue oxygenation, which is an essential factor for wound healing. The purpose of this study was to evaluate the association between macrocirculation and TcpO(2) in persons with diabetes mellitus. SUBJECTS AND SETTING: Ninety-eight patients with diabetic foot ulcers participated in the study (61 men and 37 women). The subjects had a mean age of 66.6 years (range, 30-83 years) and were treated at the Diabetic Wound Center of Korea University Guro Hospital, Seoul, Republic of Korea. METHODS: Macrocirculation was evaluated using 2 techniques: computed tomographic angiography and Doppler ultrasound. Macrocirculation scores were based on the patency of the two tibial arteries in 98 patients. Computed tomographic angiography and Doppler ultrasound scores (0-4 points) were given according to intraluminal filling defects and arterial pulse waveform of each vessel, respectively. Tissue oxygenation was measured by TcpO(2). Macrocirculation scores were statistically analyzed as a function of the TcpO(2). RESULTS: Statistical analysis revealed no significant linear trend between the macrocirculation status and TcpO(2). Biavariate analysis using the Fisher exact test, Mantel-Haenszel tests, and McNemar-Bowker tests also found no significant relationship between macrocirculation and TcpO(2). CONCLUSIONS: Computed tomographic angiography and Doppler ultrasound are not sufficiently reliable substitutes for TcpO(2) measurements in regard to determining the optimal treatment for diabetic patients.