Predictive value of 99mTc-sestamibi scintigraphy for healing of extremity amputation

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dc.contributor.authorSarikaya, Ali
dc.contributor.authorTop, Husamettin
dc.contributor.authorAygit, A. Cemal
dc.contributor.authorBenlier, Erol
dc.contributor.authorUnal, Yasin
dc.date.accessioned2024-06-12T10:51:29Z
dc.date.available2024-06-12T10:51:29Z
dc.date.issued2006
dc.departmentTrakya Üniversitesien_US
dc.description.abstractPurpose: 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.en_US
dc.identifier.doi10.1007/s00259-006-0120-8
dc.identifier.endpage1507en_US
dc.identifier.issn1619-7070
dc.identifier.issn1619-7089
dc.identifier.issue12en_US
dc.identifier.pmid16896671en_US
dc.identifier.scopus2-s2.0-33845368059en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1500en_US
dc.identifier.urihttps://doi.org/10.1007/s00259-006-0120-8
dc.identifier.urihttps://hdl.handle.net/20.500.14551/18383
dc.identifier.volume33en_US
dc.identifier.wosWOS:000242426500016en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherSpringeren_US
dc.relation.ispartofEuropean Journal Of Nuclear Medicine And Molecular Imagingen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectAmputation Levelen_US
dc.subjectScintigraphyen_US
dc.subjectTc-99m-Sestamibien_US
dc.subjectElectrical Burnen_US
dc.subjectTechnetium-99m-Sestamibi Scintigraphyen_US
dc.subjectMuscle Scintigraphyen_US
dc.subjectFrostbite Injuryen_US
dc.subjectLevel Selectionen_US
dc.subjectViabilityen_US
dc.subjectLegen_US
dc.subjectMetabolismen_US
dc.subjectPressureen_US
dc.subjectIschemiaen_US
dc.titlePredictive value of 99mTc-sestamibi scintigraphy for healing of extremity amputationen_US
dc.typeArticleen_US

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