This 1981 Current Concepts Review by Burgess and Matsen surveys eight categories of preoperative circulatory testing for predicting amputation wound healing in peripheral vascular disease. The central question: which tests can reliably guide level selection, and can the knee be preserved? No single modality is definitive; the review compares segmental pressure, skin blood pressure, Xenon-133 clearance, and transcutaneous PO2 against clinical outcomes.
40 mmHg. 100% healing (15/15)
When selecting amputation level in a patient with peripheral vascular disease, no single preoperative test is definitive — this paper established that principle clearly in 1981 and it remains true today.
Transcutaneous PO2 offers the most actionable thresholds: a value >40 mmHg at the proposed level gives high confidence to proceed with below-knee amputation, while ≤26 mmHg should prompt consideration of a more proximal level.
Segmental blood pressure, the most widely used preoperative test, has a critical threshold that varies from 40–70 mmHg across series. Do not use it as a go/no-go cutoff in isolation.
Knee preservation is the primary goal worth taking measured risk for: an elderly patient with a functional knee can often walk with a below-knee prosthesis, while above-knee amputation frequently means permanent non-ambulation in this population.
The framework introduced here. Integrating probabilistic test data with clinical judgment rather than treating any single threshold as absolute. Directly shaped how TcPO2 was subsequently validated and adopted as a standard preoperative tool in vascular and reconstructive surgery.
This 1981 Current Concepts Review by Burgess and Matsen surveys eight categories of preoperative circulatory testing for predicting amputation wound healing in peripheral vascular disease. The central question: which tests can reliably guide level selection, and can the knee be preserved? No single modality is definitive; the review compares segmental pressure, skin blood pressure, Xenon-133 clearance, and transcutaneous PO2 against clinical outcomes.
40 mmHg. 100% healing (15/15)
When selecting amputation level in a patient with peripheral vascular disease, no single preoperative test is definitive — this paper established that principle clearly in 1981 and it remains true today.
Transcutaneous PO2 offers the most actionable thresholds: a value >40 mmHg at the proposed level gives high confidence to proceed with below-knee amputation, while ≤26 mmHg should prompt consideration of a more proximal level.
Segmental blood pressure, the most widely used preoperative test, has a critical threshold that varies from 40–70 mmHg across series. Do not use it as a go/no-go cutoff in isolation.
Knee preservation is the primary goal worth taking measured risk for: an elderly patient with a functional knee can often walk with a below-knee prosthesis, while above-knee amputation frequently means permanent non-ambulation in this population.
The framework introduced here. Integrating probabilistic test data with clinical judgment rather than treating any single threshold as absolute. Directly shaped how TcPO2 was subsequently validated and adopted as a standard preoperative tool in vascular and reconstructive surgery.