Document Detail

Assessment of tissue viability in complex extremity injuries: utility of the pyrophosphate nuclear scan.
MedLine Citation:
PMID:  11242290     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Extensive extremity injuries often require difficult decisions regarding the necessity for amputation or radical debridement. During the past decade, we have used technetium-99 pyrophosphate (PyP) scanning as an adjunct in this setting. This study was performed to assess the accuracy of PyP scan in predicting the need for amputation in relation to clinical, operative, and pathologic findings. METHODS: Review of our computerized registry identified 11 patients (10 men, age 36.1 +/- 14.9 years) admitted from 1990 to 1999 who underwent PyP scan. Using operative and pathologic findings, accuracy of the PyP scan was graded as supporting or refuting the clinical assessment of the need for amputation. RESULTS: Eight patients suffered high-voltage electrical injuries, one had severe frostbite, and two suffered soft-tissue infections. In most cases, PyP scan showed clear demarcation of viable and nonviable tissue, verifying the need for amputation (positive); those that demonstrated viable distal tissues confirmed at operation were considered negative. PyP scan had a sensitivity of 94%, a specificity of 100%, and an accuracy of 96% in this setting. CONCLUSION: Technetium-99 PyP scanning is a useful adjunct in predicting the need for amputation in extremities damaged by electrical injury, frostbite, or invasive infection. In addition, by providing an objective "picture" of extremity perfusion, PyP scans can be helpful in convincing patients of the need for amputation.
D G Affleck; L Edelman; S E Morris; J R Saffle
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  50     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-12     Completed Date:  2001-04-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  263-9     Citation Subset:  AIM; IM    
University of Utah Department of Surgery, School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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MeSH Terms
Burns / pathology*,  surgery
Burns, Electric / pathology,  surgery
Cell Survival
Middle Aged
Radiopharmaceuticals / diagnostic use*
Soft Tissue Infections / pathology*,  surgery
Technetium Tc 99m Pyrophosphate / diagnostic use*
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Technetium Tc 99m Pyrophosphate

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