Lower extremity amputation level: selection using noninvasive hemodynamic methods of evaluation.

The superior rehabilitative potential of the below knee amputee versus the above knee amputee is well known. In end-stage occlusive vascular disease, the limiting factor in determining how distal an amputation can be performed is whether or not the stump will heal. The use of clinical judgement to determine the correct amputation level has historically been proven to be too subjective. Therefore, several procedures have been proposed which would hopefully fulfill the need for a reliable, objective method for determining the optimal amputation level. These procedures include the measurement of local and cutaneous blood flow and pressure, blood volume, and skin temperature. After evaluating the studies done on each of these procedures, it is evident that the measurement of skin capillary blood flow is the most accurate parameter for predicting wound healing potential.