PREDICTIVE VALUE OF SNAPSHOTNIR IMAGES FOR ASSESSING A BK AMPUTATION VIABILITY OF A DFU
Presented by: Ronald Ray, DPM, FACFAS, WCC, PT
PATIENT HISTORY
A 68-year-old male with Type II diabetes, hypertension, hyperlipemia, Grade 1 diastolic heart failure, COPD, and pulmonary hypertension presented to the clinic with a chronic Grade IV ulceration at the medial aspect of the first metatarsophalangeal joint on the left foot.
CASE DETAILS
The patient had non-palpable femoral, popliteal, dorsalis pedis, and posterior tibial pulses bilaterally. Capillary filling time to the left hallux and lesser digits was greater than 7 seconds and the left foot was cold.
Radiographs of the left foot revealed diffuse osteopenia but no lytic or destructive changes in the left forefoot. A CT scan was also obtained and did not reveal any bone lysis or destructive changes to the first metatarsal head or in the proximal and distal phalanx of the left hallux.
SnapshotNIR was used to determine if the patient would qualify for an amputation. The images derived from SnapshotNIR showed tissue oxygen saturation (StO2) values in the low 40s and 50s in the peri-wound area. The values around the distal heel of the foot ranged from 60s to 70s.
Clinical image (1A) and X-ray scan (1B) of left foot with a Grade-IV ulceration with dry eschar.
IMPACT
With significantly compromised tissue oxygenation in wound/peri-wound area, the amputation was not performed due to the lack of oxygenation and concern that surgical intervention would lead to a failure of the amputation site during the procedure. With no bone involvement, the management plan included the use of hyperbaric oxygen therapy (HBOT) and reassessment of the patient every 3-4 weeks, watching for signs of infection or a positive response to treatment.
“SnapshotNIR provides both an immediate assessment of the StO2 of a given area and a level of predictability about how a wound will likely heal when deciding on different treatment options. When considering an amputation for a patient, low StO2 values suggest poor healing capabilities for that area. Therefore, alternative treatment options should be pursued and more aggressive treatments should be postponed until the poor oxygenation levels have been addressed.”