Selection of amputation level. Comparison between morphine puncture test and skin perfusion pressure.

In 46 amputations performed on account of peripheral occlusive arterial disease, the morphine puncture test (MPT) and the local skin perfusion pressure measurement (SPP) were carried out preoperatively. Below-knee (BK) amputation was performed when the SPP was greater than or equal to 40 mm Hg unless clinical criteria indicated otherwise. Out of 12 BK amputations without any clinical skin changes, where the SPP was greater than or equal to 40 mm Hg but the MPT was negative, healing was achieved in 11 patients. Thus, if the MPT had been used as an objective method to determine the amputation level, 11 knees would have been sacrificed. The MPT is thus not suitable for determination of amputation level in patients with peripheral occlusive arterial disease.