Predictive value of 99mTc-sestamibi scintigraphy for healing of extremity amputation
Küçük Resim Yok
Tarih
2006
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Springer
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Purpose: Although various non-invasive procedures have been proposed to determine the optimal level of amputation of limbs in patients who have vascular disease, currently there are no consistent criteria that can be applied before surgery. The purpose of this study was to determine whether Tc-99m-sestamibi imaging can accurately predict the healing of amputation sites. Methods: In a prospective study in 26 patients ( 21 men, 5 women; age range 23 - 94 years) presenting with ulcers or gangrene of the foot and hand, Tc-99m-sestamibi imaging was performed preoperatively. The indications for amputation included gangrene ( 23 patients), electrical injury ( 2 patients) and trauma ( 1 patient) of extremities. Although the amputation levels were chosen according to clinical criteria and scintigraphic results, the final amputation level was defined by scintigraphic results. Two below-knee, one above-knee, 12 toe, 11 transmetatarsal, two phalanx, one finger and one thumb amputations and one shoulder disarticulation were performed. In four cases, the amputation defect was not suitable for coverage using a local dermal flap; rather, it was covered with free tissue transfer. Patients had clinical follow-up for 6 - 36 months ( mean 11.69 months) to assess healing of the stump. Scan results were compared with clinical outcome to assess prediction of healing. Results: There was healing in all amputations at the end of the follow-up period. When evaluated regarding preoperative Tc-99m-sestamibi uptake pattern, there was no perfusion to the lesion site in 21 patients and perfusion to an area smaller than the extent of skin necrosis in four patients; thus, in these 25 patients, Tc-99m-sestamibi scintigraphy suggested non-viable tissue in the extremities with clear-cut edges of perfused muscle tissue. Diffusely decreased uptake was seen below the left knee in one case. How scintigraphy changed management was analysed. The amputation levels proposed before scintigraphy were divided into two groups, definite (n=14) and indefinite ( n= 12), based on visual examination and Doppler findings. In nine patients in the definite group, the proposed amputation level before scintigraphy was not altered by the scintigraphic data. However, Tc-99m-sestamibi scan enabled unnecessarily high amputation levels to be avoided in 12 patients in the indefinite group and in five patients in the definite group. Therefore, there was change in management of 65% of cases based on scintigraphic findings. Conclusion: Since healing of the stump was seen in all cases, outcome was correctly predicted by scintigraphy. This preliminary study supports the use of Tc-99m-sestamibi scan in selecting the optimal amputation level consistent with subsequent stump healing.
Açıklama
Anahtar Kelimeler
Amputation Level, Scintigraphy, Tc-99m-Sestamibi, Electrical Burn, Technetium-99m-Sestamibi Scintigraphy, Muscle Scintigraphy, Frostbite Injury, Level Selection, Viability, Leg, Metabolism, Pressure, Ischemia
Kaynak
European Journal Of Nuclear Medicine And Molecular Imaging
WoS Q Değeri
Q1
Scopus Q Değeri
Q1
Cilt
33
Sayı
12
