The Use of Skin Temperature Determinations in Lower Extremity Amputation Level Selection

Skin temperatures were recorded preoperatively with a surface temperature probe in 30 limbs of 26 patients undergoing amputations for peripheral vascular disease. A significant correlation was established between the temperature readings and stump survival at the selected levels. All amputation levels with temperature readings above 32 ° C healed, and all those with readings below 30.5 ° C failed to heal. If the difference between skin temperature and room temperature was less than 5 ° C the amputation generally failed. The functional superiority of below-the-knee over high level amputations has initiated a trend toward more distal level amputations in patients with periph-eral vascular disease. Although patients with more distal level amputations most often have shorter re-habilitation times and improved function, failures oc-cur because of inadequate vascularity to support heal-ing at the lower ievets. " The determination of ampu-tation levels in patients with ischemia and/or gan-grene of the lower extremity secondary to peripheral vascular disease has been based on a number of clinical criteria including skin nutrition, pulses, skin temperature by palpation, skin color, skin bleeding in surgery, angiography, and noninvasive techniques such as segmental blood pressure measurements. ',2,7 None of these techniques have been consistently re-liable in predicting skin healing, however. Angiogra-phy and segmental blood pressure measurements have been criticized because they measure the status of larger arteries and arterioles and not the skin cap-illaries which are important in skin healing. Ideally, a method which directly or indirectly measures the skin blood flow at the selected level of amputation should provide a more reliable guide to selecting the most distal level of amputation compatible with healing. In 1959, Peacock": " correlated cutaneous temper-ature and skin blood flow using venous occlusio