Histomorphometric changes in the vessel wall at the site of amputation in diabetic patients--do they influence healing of the stump?

PURPOSE To predict healing of the stump by assessing the microscopic vascular changes at the amputation site. METHODS A cohort study was conducted on 39 patients, 18 of them had below-knee amputation (group A) and 21 had ray amputation of a single toe (group B). Biopsies were taken from the anterior and posterior tibial arteries and the venae comitantes of group A patients. For group B patients, biopsies of the digital artery and dorsal vein of the toe were taken. RESULTS In group A, 15 patients required no further amputation (group A1) and 3 underwent a further above-knee amputation (group A2). In group B, 16 required no further amputation (group B1) and 5 underwent a below-knee amputation (group B2). Lumen narrowing caused by intimal thickening of the arteries was significantly different between groups A1 and A2 (p<0.05). Lumen narrowing of the dorsal veins between groups B1 and B2 was also significantly different (p<0.05). The proportion of the vessel walls made up of intima and media was significantly different in both A1 and A2 as well as B1 and B2 groups. The proportion of total wall thickness over the total diameter of the vessel was not significantly different between both subgroups of A and B. CONCLUSION Intimal thickening and medial thinning in the arteries can be used to predict the stump healing in patients who underwent below-knee amputation. For ray amputation patients, similar changes occurred in the dorsal veins, and this finding can also be used to predict the healing of the stump. However, intimal thickening occurred at the expense of the media; therefore, there is little change in the wall thickness.