Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? A systematic review and meta-analysis.

ABSTRACT:

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.

SUBMITTER: Linton C 

PROVIDER: S-EPMC7607408 | biostudies-literature | 2020 Mar-Apr

REPOSITORIES: biostudies-literature