Importance of skin perfusion pressure in treatment of critical limb ischemia

The authors studied whether skin perfusion pressure (SPP) measurements can be used to accurately predict wound healing in critical limb ischemia (CLI) and to select peripheral arterial reconstructive procedures. Methods. Forty-seven patients (33 men and 14 women, age 36-83 years) with 69 ischemic limbs with foot ulcers or gangrene were studied retrospectively. Skin perfusion pressure was compared to the treatment outcomes (ulcers healed and ulcers that failed to heal). As a diagnostic test for CLI, the sensitivity, specificity, and the positive and the negative predictive values (PPV, NPV) of SPP measurement were calculated; the data was then analyzed by the receiver operation characteristic (ROC) curve. Results, According to the ROC curve, the best SPP measurement performance was at 35 mmHg. Conclusion. Wound healing at the appropriate amputation level must be predicted to minimize invasive debridement. Skin perfusion pressure measurement is useful for predicting wound healing in the presence of CLI. Skin perfusion pressure >= 35 mmHg is requisite for wound healing; at SPP < 35 mmHg, peripheral arterial reconstruction is necessary before debridement.