The distal blood pressure predicts healing of amputations on the feet

Holstein, P.

doi:10.3109/17453678408992343

Cited by 42 publications

(33 citation statements)

References 18 publications

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“…It has predictive value for delayed wound healing 10 and amputation. 11 An ABI < 0.9 is 95% sensitive and almost 100% specific in detecting angiogram-positive disease. 12 Critical ischaemia is defined by an ABI < 0.5.…”

Section: Discussionmentioning

confidence: 99%

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

Rheeder

Wyk

Stolk

et al. 2004

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Peripheral vascular disease is 2 -3 times more likely to develop in people with diabetes mellitus (DM) than in the general population.1 It can occur in 8% of people at the time of diagnosis of DM and may reach 45% by 20 years' duration. 2There are no published data on the prevalence of peripheral artery disease (PAD) or medial arterial calcification in an unselected group of black South African patients with DM. Traditionally it is thought that South African blacks have a lower incidence of vascular disease than their white counterparts. In the studies 3,4 examining PAD as seen in a vascular unit in Durban the pattern of atherosclerotic disease varied between the different ethnic groups reviewed, with black patients suffering more from peripheral aneurysms than aortic aneurysm and generally having more limb-threatening peripheral vascular disease than exercise-limiting claudication. The black population generally had a higher concentration of high-density lipoproteins than the white or Indian populations. The black patients presented much later in the process than the other population groups. PAD is therefore well established in blacks but the incidence is still lower compared with that of other ethnic groups. The reason for these differences still needs careful investigation.The screening evaluation of the foot of a person with DM should include palpation of pedal pulses and if pulses are absent or decreased a more specific vascular evaluation is indicated (particularly if the tibialis posterior pulse is absent). 2In general, this means a Doppler evaluation of ankle and brachial systolic pressures defined as an ankle brachial index (ABI) with ratio less than 0.9 indicating peripheral vascular disease. Because medial arterial calcification can cause falsely elevated pressures some advocate the use of toe systolic blood pressure indices in subjects with DM.2 At least one study has shown that in the absence of overt calcification (ABI ≥ 1.3) the toe systolic blood pressure indices convey no advantage over ABI in determining perfusion pressure of the lower limbs. 5No data are available on this topic in African black diabetic patients, where the prevalence would probably be lower and the value of the ABI in these patients is still regarded as questionable. Therefore, the aim of our study was to determine the concordance between ankle Doppler indices and toe systolic blood pressure indices as well as to determine the value of pedal pulse palpation in the assessment of PAD. MethodsThe setting for this cross-sectional study was Mamelodi Hospital, a community hospital serving mainly as a primary health care facility for the urban black community of Objectives. To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM).Design. Cross-sectional study.Subjects. A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a c...

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Section: Discussionmentioning

confidence: 99%

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

Rheeder

Wyk

Stolk

et al. 2004

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…23 General problems in wound treatment and patient care were determined to be lack of standardized treatment and referral plans; lack of multidisciplinary collaboration; lack of evaluation plans of the given treatment; lack of knowledge of health care personnel, patients, and administrative persons; lack of treatment structure for uses the toe-pressure measurements as the "gold standard" of the degree of arterial insufficiency. [31][32][33][34] Transcutaneous oxygen tension is presently used scientifically but may be a clinical standard in the future.…”

Section: Clinical Activitymentioning

confidence: 99%

A New Concept of a Multidisciplinary Wound Healing Center and a National Expert Function of Wound Healing

Gottrup

Holstein²,

Jørgensen³

et al. 2001

Arch Surg

153

112

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Hypothesis: An independent, multidisciplinary wound healing center in an accepted national expert function of wound healing is the optimal way to improve prophylaxis and treatment of patients with problem wounds.Design: A clinical perspective analysis.Setting: An independent, multidisciplinary wound healing center focusing on all types of problem wounds, organized as a university hospital department, and integrated in an expert function in the national health care organization of Denmark.Patients and Methods: Patients with all types of problem wounds referred to and treated in the center during the first years of its existence provided a model for a new multidisciplinary structure for treatment of wound patients in the health care system.Results: During the first 3 years of the fully functioning wound healing center, a total of 23 802 patient consultations were performed in the outpatient clinic, and 1014 patients with problem wounds were hospitalized in the inpatient ward. The surgical concept of the center

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“…Per Holstein (11,12), based on his 20 years of experience with this technique. The spontaneous healing of ulcers was shown to be predicted by this measurement, such that a TSBP <20 mmHg was associated with only a 29% healing rate compared with a healing rate of 92% for subjects with a TSBP >30 mmHg.…”

mentioning

confidence: 99%

Assessment of Peripheral Vascular Disease in Diabetes: Report and Recommendations of an International Workshop Sponsored by the American Heart Association and the American Diabetes Association

1993

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R ecognizing the considerable excess burden of both cerebrovascular disease and LEAD suffered by individuals with IDDM or NIDDM (1,2), a workshop was convened to 1) provide a current review of the knowledge pertaining to the prevalence, incidence, and risk factor associations of cerebrovascular disease and PVD in diabetes, and 2) review and make recommendations about the methodology for identifying and quantifying LEAD in both clinical and research settings.The workshop focused on the specific problems of measurement of PVD in diabetes and the need for a standard approach to ensure appropriate care and facilitate comparability of research findings across studies and over time. Recommendations for the measurement of LEAD in a primary-care setting and for epidemiological studies were developed, along with recommendations for more detailed assessment after referral to a vascular clinic. Specific recommendations for the assessment of cerebrovascular disease were not addressed.

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The distal blood pressure predicts healing of amputations on the feet

Cited by 42 publications

References 18 publications

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

A New Concept of a Multidisciplinary Wound Healing Center and a National Expert Function of Wound Healing

Assessment of Peripheral Vascular Disease in Diabetes: Report and Recommendations of an International Workshop Sponsored by the American Heart Association and the American Diabetes Association

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