TcPO2 cut off for diabetic foot ulcer healing

NewsBot · Nov 11, 2013

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Transcutaneous oxygen pressure measurement in diabetic foot ulcers: mean values and cut-point for wound healing.
Yang C, Weng H, Chen L, Yang H, Luo G, Mai L, Jin G, Yan L.
J Wound Ostomy Continence Nurs. 2013 Nov-Dec;40(6):585-9.

PURPOSE:
The purpose of this study was to investigate mean values and cut-point of transcutaneous oxygen pressure (TcPO2) measurement in patients with diabetic foot ulcers.
DESIGN:
Prospective, descriptive study.
SUBJECTS AND SETTING:
Sixty-one patients with diabetes mellitus and foot ulcers comprised the sample. The research setting was Sun Yat-sen Memorial Hospital of SunYat-sen University, Guangzhou, China.
METHODS:
Participants underwent transcutaneous oxygen (TcPO2) measurement at the dorsum of foot. Patients were classified into 3 groups according to clinical outcomes: (1) ulcers healed with intact skin group, (2) ulcer improved, and (3) ulcer failed to improve. TcPO2 was assessed and cut-points for predicting diabetic foot ulcer healing were calculated.
RESULTS:
Thirty-six patients healed with intact skin, 8 experienced improvement, and 17 showed no improvement. Mean TcPO2 levels were significantly higher (P< .001) in healed ulcers with intact skin (32 ± 10 mmHg) when compared to the improvement group (30 ± 7 mmHg) and the nonhealing group (15 ± 12 mmHg). All patients with TcPO2≤ 10 mmHg failed to heal or experienced deterioration in their foot ulcers. In contrast, all patients with TcPO2≥ 40 mmHg achieved wound closure. Measurement of TcPO2 in the supine position revealed a cut-point value of 25 mmHg as the best threshold for predicting diabetic foot ulcer healing; the area under the curve using this cut-point was 0.838 (95% confidence interval = 0.700-0.976). The sensitivity, specificity, positive predictive value, and negative predictive value for TxPO2 were 88.6%, 82.4%, 90.7%, and 72.2%, respectively.
CONCLUSION:
TcPO2≥ 40 mmHg was associated with diabetic foot ulcer healing, but a TcPO2≤ 10 mmHg was associated with failure of wound healing. We found that a cut-point of 25 mmHg was most predictive of diabetic foot ulcer healing.
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Admin2 · Nov 11, 2013

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NewsBot · Jun 30, 2014

Transcutaneous oxygen pressure (TcPO2): a novel diagnostic tool for peripheral neuropathy in type 2 diabetes patients
Wuquan Deng etal
Diabetes Research and Clinical Practice; Available online 25 June 2014

Aims
The assessment of transcutaneous oxygen pressure (TcPO2) may serve as a non-invasive and lower-cost alternative to nerve conduction studies (NCSs) for the diagnosis of diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether the measurement of TcPO2 is useful for evaluating DPN.
Methods
We performed a cross-sectional study of 381 consecutive hospitalized diabetic patients classified by clinical examination and NCS as having DPN. Anthropometric and metabolic parameters were assessed. The TcPO2 examination was performed in both supine and sitting positions.
Results
Three hundred and one patients had DPN. The TcPO2 in both the supine and sitting positions was highest in the Non-DPN group and lower in the confirmed DPN group than the other three groups (p < 0.001). The Non-DPN group had the lowest sitting-supine position difference in TcPO2 among the groups (p < 0.001). The risk factors strongly associated with DPN included sitting-supine position difference in TcPO2 (OR =4.971, p < 0.001), diabetic retinopathy (DR) (odds ratio [OR] =3.794, p =0.002), and HbA1c (OR =1.534, p =0.033). The area under the curve (AUC) of the sitting-supine position difference in TcPO2 was 0.722 and revealed an optimal cutoff point for the identification of DPN (19.5 mmHg) that had a sensitivity of 0.611 and a specificity of 0.738 based on AUC analysis.
Conclusions
This large study of diabetic patients confirms that the sitting-supine position difference in TcPO2 is higher in DPN patients than control subjects, indicating that TcPO2 examination is a promising valuable diagnostic tool for DPN.
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NewsBot · May 6, 2018

Transcutaneous oxygen pressure as a predictor for short‑term
survival in patients with type 2 diabetes and foot ulcers: a comparison
with ankle–brachial index and toe blood pressure
K. Fagher et al
Acta Diabetologica: 11 April 2018

Aims Ankle–brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is
considered a marker for cardiovascular risk. Transcutaneous oxygen pressure (TcPO2), a test associated with microvascular
function, has in several studies shown better correlation with diabetic foot ulcer (DFU) healing. Whether a low TcPO2 could
be a marker for mortality in the high-risk population of DFU patients has not been evaluated before. The aim of this study
was to evaluate the predictive value of TcPO2 in comparison with ABI and toe blood pressure (TBP) on 1-year mortality
in type 2 diabetes patients with DFU.
Methods Type 2 diabetes patients aged≤90 years, with one DFU who attended our multidisciplinary DFU-unit during year
2013–2015 and were screened with TcPO2, ABI and TBP were retrospectively evaluated. One-year mortality was assessed
from the national death register in Sweden.
Results A total of 236 patients (30% women) with a median age of 76 (69–82) years were evaluated in this study. Within
1 year, 14.8% of the patients died. TcPO2<25 mmHg was associated with a higher 1-year mortality compared with
TcPO2≥25 mmHg (27.7 vs. 11.6%, p=0.003). TBP and ABI did not signifcantly infuence 1-year mortality. In a Cox
regression analysis adjusted for confounders, TcPO2 was independently predicting 1-year mortality with a hazard ratio for
TcPO2<25 mmHg of 2.8 (95% CI 1.34–5.91, p=0.006).
Conclusions This study indicates that a low TcPO2 is an independent prognostic marker for 1-year mortality among patients
with type 2 diabetes and DFU.
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NewsBot · Oct 27, 2018

Toe Pressure in Predicting Diabetic Foot Ulcer Healing: A Systematic Review and Meta-Analysis
Tay Wei Ling, et al
November 2018Volume 68, Issue 5, Supplement, Page e123

Objective: There is a significant body of evidence supporting the clinical utility of toe systolic blood pressure (TBP) as an indicator of peripheral blood flow in diabetic foot ulcers (DFUs) and consequently in predicting healing capacity. However, there is still little consensus in the literature on the relevant cutoff values. This systematic review seeks to evaluate the sensitivity and specificity of toe pressure measurements in prediction of DFU wound healing and to investigate for a cutoff value to predict healing as supported by current evidence. Methods: PubMed, MEDLINE, and Embase databases were systematically searched up to September 20, 2017, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All randomized controlled prospective and retrospective trials were considered for inclusion if they reported healing rates of DFUs with respect to different TBP readings. Healing was defined as intact skin for at least 6 months or at time of death. Quality assessment of articles was performed using RevMan (The Nordic Cochrane Center, Copenhagen, Denmark). Information on healing rates with respect to different TBP values was extracted. Summary estimates of sensitivity and specificity of TBP in predicting healing of DFU wounds were obtained using a bivariate model. Results: A total of 580 articles were screened. Eight studies (six prospective and two retrospective) inclusive of 909 patients were eligible for inclusion. It was found that a TBP of >30 mm Hg is associated with a sensitivity and specificity of 0.86 and 0.58, respectively, for healing of DFUs. Conclusions: A TBP of >30 mm Hg is sensitive but not specific in the prediction of healing of DFUs. Because of its portability and quick analysis, TBP may be used as a bedside assessment to predict the healing of DFUs.
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NewsBot · Dec 30, 2018

Skin Perfusion Pressure and Wound Closure Time in Lower Extremity Wounds.
Suzuki K et al
J Am Coll Clin Wound Spec. 2018 Oct 9;9(1-3):14-18. doi: 10.1016/j.jccw.2018.10.001. eCollection 2017.

INTRODUCTION:
Peripheral Arterial Disease (PAD) affects approximately 8 million patients in the United States. We investigate the relationship of Skin Perfusion Pressure (SPP) and wound closure time in lower extremity wounds.

METHODS:
We conducted a retrospective study of 1125 lower extremity wounds in 998 patients between June 2006 and October 2014 in our wound clinic. We analyzed the relationship between SPPand wound closure time. SPP was measured using a Laser Doppler instrument.

RESULTS:
Patients with SPP values over 30 mmHg had shorter wound closure times, while patients with SPP values below 30 mmHg had a significantly longer wound closure time. Diabetic patients took longer to achieve wound closure compared to non-diabetics. No significant relationship was observed between SPP and wound closure time in relation to age or gender.

CONCLUSION:
SPP is a useful tool in estimating time to wound closure and assessing the necessity of vascular interventions in lower extremity wounds.
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NewsBot · Jun 17, 2020

Do Toe Blood Pressures Predict Healing After Minor Lower Limb Amputation in People With Diabetes? A Systematic Review and Meta-Analysis
Clare Linton et al
Diab Vasc Dis Res. Mar-Apr 2020;17(3)

Purpose of study: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations.

Key methods: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist.

Main results: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37-3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8.

Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.
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NewsBot · Jan 17, 2021

Evolution of the TcPO2 values following hyperoxygenated fatty acids emulsion application in patients with diabetic foot disease: results of a clinical trial
José Luis Lázaro-Martínez et al
Journal of Wound CareVol. 30, No. 1 Practice
13 Jan 2021https://doi.org/10.12968/jowc.2021.30.1.74

Objective:

The use of emollients to lubricate dry skin to prevent diabetic foot ulcers (DFUs), especially in neuroischaemic feet, has been recommended. This study analyses the effect of daily topical application of hyperoxygenated fatty acids emulsion on transcutaneous oxygen pressure (TcPO2) in the feet of neuropathic and neuroischaemic patients with diabetes.
Method:

Patients with diabetes and no active foot ulcer were included in this longitudinal, prospective, non-comparative clinical trial. The evolution of TcPO2 (mmHg) values after the application of the tested emulsion (Corpitol Emulsion, Laboratoires Urgo Medical, France) was evaluated for a three-month period. Modifications of skin features (skin dryness, skin shedding and skin colour) were also analysed. TcPO2 was performed using a TCM400 device (Radiometer, Denmark).
Results:

A total of 50 patients were included in the study. Patients with neuroischaemia showed a significant increase in TcPO2 values (35.69±13.88mmHg) after two months' application of the tested emulsion that remained at month three (day 60: 42.34±10.98mmHg; p=0.006; day 90: 41.62±10.88mmHg; p=0.011). Skin dryness and shedding showed an improvement from baseline to the end of the study in both groups, secondary to the use of the tested emulsion (p<0.001 and p<0.001, respectively). Skin colour also showed differences from baseline to the final visit in the neuroischaemic patients (p=0.029). Patients with neuropathy did not show any change in skin colour from baseline to the final visit.
Conclusions:

Analysis of the use of the tested emulsion showed an increase in TcPO2 and an improvement in skin trophism in patients with neuroischaemic foot.
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NewsBot · Dec 27, 2021

Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot
Vladimíra Fejfarová et al
Front Endocrinol (Lausanne). 2021 Dec 10

Background: All diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test.

Methods: The study comprised patients with mild-to-moderate PAD(WIfI-I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups.

Results: During the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI.

Conclusion: Compared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients.
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NewsBot · Oct 16, 2023

Analyses of transcutaneous oxygen pressure values stratified for foot angiosomes to predict diabetic foot ulcer healing
Mateo López-Moral, Marta García-Madrid, Raúl J. Molines-Barroso, Yolanda García-Álvarez, Aroa Tardáguila-García, José Luis Lázaro-Martínez
Journal of Tissue Viability; 10 October 2023

Highlights
•Transcutaneous oxygen pressure analysis is one of the most studied tools to predict diabetic foot ulcer healing in the literature.
•Previous authors suggested that diabetic foot ulcer location could affect TcPO2 values following the angiosome concept.
•Transcutaneous oxygen pressure guided angiosome improves healing prognosis in diabetic foot ulcers.
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Aims
Previous research suggested that diabetic foot ulcer (DFU) location could affect transcutaneous oxygen pressure (TcPO2) values following the angiosome concept. Up to our knowledge no studies have yet analyzed if the location of a diabetic foot ulcer can be a confounding factor that modifies TcPO2 values. The primary aim of this study was to compare the potential healing prognosis of TcPO2 differentiated for diabetic foot ulcers in different angiosome locations.

Methods
a 2-years observational cohort prospective study was performed in 81 patients with diabetic foot ulcers. Transcutaneous oxygen pressure measurements were performed at baseline by placing the electrode on two different angiosomes: dorsal zone of the foot (dorsalis pedis angiosome) and between the navicular bone and the tibial malleolus (posterior tibial angiosome). The main outcome was establishing the effectiveness of TcPO2 measurements (dorsalis pedis angiosome and posterior tibial angiosome) for predicting DFU healing.

Results
Transcutaneous oxygen pressure probe placed in the dorsum of the foot (dorsalis pedis angiosome) yielded a sensitivity (S) of 95 % and specificity (SP) of 73 %, and an area under the curve (AUC) of 0.902 (p < 0.001 [0.84–0.96]) for ulcers located in the forefoot and toes; while TcPO2 placed in the posterior tibial angiosome yielded an S of 100 % and SP of 85 % and an AUC of 0.894 (p < 0.001 [0-822-0.966]) for DFU located in the midfoot and heel.

Conclusion
This study suggests that angiosome-guided TcPO2 contributes to a prognosis of successful foot ulcer healing.
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NewsBot · Oct 25, 2023

Analyses of transcutaneous oxygen pressure values stratified for foot angiosomes to predict diabetic foot ulcer healing
Mateo López-Moral et al
J Tissue Viability. 2023 Oct 10:S0965-206X(23)00106-7

Aims: Previous research suggested that diabetic foot ulcer (DFU) location could affect transcutaneous oxygen pressure (TcPO2) values following the angiosome concept. Up to our knowledge no studies have yet analyzed if the location of a diabetic foot ulcer can be a confounding factor that modifies TcPO2 values. The primary aim of this study was to compare the potential healing prognosis of TcPO2 differentiated for diabetic foot ulcers in different angiosome locations.

Methods: a 2-years observational cohort prospective study was performed in 81 patients with diabetic foot ulcers. Transcutaneous oxygen pressure measurements were performed at baseline by placing the electrode on two different angiosomes: dorsal zone of the foot (dorsalis pedis angiosome) and between the navicular bone and the tibial malleolus (posterior tibial angiosome). The main outcome was establishing the effectiveness of TcPO2 measurements (dorsalis pedis angiosome and posterior tibial angiosome) for predicting DFU healing.

Results: Transcutaneous oxygen pressure probe placed in the dorsum of the foot (dorsalis pedis angiosome) yielded a sensitivity (S) of 95 % and specificity (SP) of 73 %, and an area under the curve (AUC) of 0.902 (p < 0.001 [0.84-0.96]) for ulcers located in the forefoot and toes; while TcPO2 placed in the posterior tibial angiosome yielded an S of 100 % and SP of 85 % and an AUC of 0.894 (p < 0.001 [0-822-0.966]) for DFU located in the midfoot and heel.

Conclusion: This study suggests that angiosome-guided TcPO2 contributes to a prognosis of successful foot ulcer healing.
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NewsBot · Dec 20, 2023

Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?
Da Woon Lee et al
World J Clin Cases. 2023 Nov 6;11(31):7570-7582

Background: Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.

Aim: To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).

Methods: TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.

Results: Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.

Conclusion: Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
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NewsBot · Feb 16, 2024

Use of consecutive transcutaneous oxygen measurement when assessing the need for revascularization and association with the outcomes of ischemic diabetic ulcers
Hao-Yi Sun et al
Int Wound J. 2024 Jan;21(1)

This study compared the ankle-brachial index (ABI) with transcutaneous oxygen pressure (TcPO2 ) in assessing peripheral vascular disease (PVD) prevalence in 100 diabetic foot ulcer (DFU) patients. Patients were categorized into vascular or nonvascular reconstruction groups and underwent both ABI and TcPO2 measurements four times over 6 months. Predictive validity for PVD diagnosis was analysed using the area under the receiver-operating characteristic curve (AUC). The study found TcPO2 to be a superior predictor of PVD than ABI. Among the DFU patients, 51 with abnormal TcPO2 values underwent vascular reconstruction. Only TcPO2 values showed significant pretreatment differences between the groups and increased post-reconstruction. These values declined over a 6-month follow-up, whereas ABI values rose. For those with end-stage renal disease (ESRD), TcPO2 values saw a sharp decrease within 3 months. Pre-reconstruction TcPO2 was notably lower in amputation patients versus limb salvage surgery patients. In conclusion, TcPO2 is more effective than ABI for evaluating ischemic limb perfusion and revascularization necessity. It should be prioritized as the primary follow-up tool, especially for ESRD patients.
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