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March 1975

Perfusion of Ischemic Ulcers of the Extremity: A Prognostic Indicator of Healing

Author Affiliations

From the division of nuclear medicine (Drs. Siegel, Rhodes, and Wagner) and diagnostic radiology (Dr. Giargiana) and the Department of Surgery (Dr. Williams), Johns Hopkins Medical Institutions, Baltimore.

Arch Surg. 1975;110(3):265-268. doi:10.1001/archsurg.1975.01360090035007

Forty patients with an ischemic ulcer of the lower extremity had peripheral vascular perfusion studies, performed with intra-arterial injections of aggregated technetium Tc 99m serum albumin microspheres (15μ to 30μ in diameter), in an attempt to develop an objective prognostic criterion for healing. The association between ulcer healing and the presence or absence of diabetes mellitus, palpable peripheral pulses, and patent trifurcation vessels on the arteriogram was reviewed and no association was noted. When, however, there was a relative hyperemia of the ulcer bed in comparison to the adjacent tissue of at least 3.5:1, as determined by counting the amount of radioactivity per unit area, 86% of patients went on to heal their ulcers. In those without this degree of hyperemia, only 11% were healed with conservative nonsurgical management. The results have shown that relative hyperemia of the ulcer bed is a clinically useful prognostic indicator in the patient with ischemic ulcer disease.

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