The Journal of Bone and Joint Surgery, Vol 64, Issue 6 880-882, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
The assessment of skin viability using fluorescein angiography prior to amputation
TL Tanzer and JG Horne
Fluorescein angiography was used for the preoperative assessment of skin
viability and the determination of the level of amputation in patients with
peripheral vascular disease. In twenty-two patients requiring twenty-seven
lower-extremity amputations (including five revisions), a retrospective
comparison was made between the surgeon's choice of amputation level based
on clinical criteria and that based on the fluorescein angiogram. As was
evident by the failure of the amputation to heal, the surgeon's prediction
was too distal in nine (33 per cent) of twenty-seven amputations and
revisions. The assessor of fluorescein angiograms predicted five of these
nine failures; therefore, the failure rate could have been reduced to four
(15 per cent) of twenty-seven amputations. The amputation level predicted
on the basis of the fluorescein angiogram was unnecessarily high in three
lower limbs (11 per cent). These three amputations healed at the level
chosen by the surgeon, but did so by prolonged secondary healing.
Fluorescein angiography is a simple, safe, and useful preoperative bedside
technique for the assessment of skin viability and the determination of
amputation level in patients with peripheral vascular disease.
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