Peripheral Arterial Pressures

To the Editor: Jeffrey Falkel's review of the factors associated with amputation in patients with diabetes mellitus (Phys Ther 63:960–964,1983) was both thorough and well directed, particularly in its emphasis on atherosclerosis as the primary cause of blood flow obstruction. Like most reviews, however, Dr. Falkel's was by necessity limited in scope.

Many physical therapists treat diabetic patients with PVD who are in the second or third diagnostic stages of Kramer and Perilstein; that is, they are as stated by Falkel “threatened with gangrene based on cellulitis or discoloration or with ulceration of the skin” or “with actual gangrene with evidence of focal or extensive necrosis of an area.” Therefore, clinicians may benefit from an elaboration of the relationship between peripheral systolic arterial pressures and the outcome of conservative treatments applied to lower extremity wounds in an effort to avert amputation.…

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