Determining the precise level of lower limb amputation using photoluminescence spectroscopy

Abstract

BACKGROUND: The development of new and more precise methods for determining the boundary between necrotic and viable tissue is essential for accurately determining the level of amputation.

AIM: The study aimed to evaluate the first results of ultraviolet photoluminescence spectroscopy in determining the level of the proposed amputation of the lower limb.

METHODS: This prospective, open-label, and non-randomized study included 20 patients with critical lower limb ischemia and suspected toe gangrene who underwent percutaneous transluminal balloon angioplasty. The patients were divided into two groups. Group 1 (n = 10) included patients who did not require major limb amputation during follow-up, whereas group 2 (n = 10) included patients who underwent above-knee amputation during follow-up. The groups were comparable in age (62.5 [53.25; 74.5] years in group 1; 65.5 [60.5; 76] years in group 2; p = 0.352). All patients underwent clinical monitoring and serial photoluminescence measurements of the affected limb using a device composed of a laser radiation source (diode laser) as the excitation signal and a mini-spectrometer for signal detection. Measurements were performed during hospitalization and at re-admission. The luminescence amplitude was correlated with the clinical manifestations of critical limb ischemia during inpatient treatment and at follow-up hospitalization. A one-month post-discharge telephone follow-up was conducted to monitor patient status. In cases of recurrent critical ischemia and gangrene progression, patients were re-hospitalized for above-knee re-amputation. The results are presented as mean values, standard deviations, or medians with the 25th and 75th percentiles.

RESULTS: Following vascular reconstruction of the affected limb, a statistically significant decrease in luminescence amplitude was observed at 400 and 420 nm (nicotinamide adenine dinucleotide peak) and 450 nm (negative hemoglobin peak) in group 1 compared with preoperative levels in the critical ischemia zone (98.5 [52.9; 508.6] × 10⁵ photons before surgery; 81.5 [42.9; 117.4] × 10⁵ photons after surgery; p = 0.001]). No significant amplitude changes were observed in group 2 before and after surgery (p = 0.245). In the gangrene zone, all amplitude values at 400–600 nm exhibited minimal intensity values. Near the visible boundary between necrotic and healthy tissue, a sharp increase in photoluminescence amplitude was detected, with a difference of 81.2 (42.9; 120.4) × 10⁵ photons at 450 nm.

CONCLUSION: Laser-induced ultraviolet photoluminescence spectroscopy may serve as a potential method for determining the precise level of amputation in cases of dry gangrene of the lower limb.

Keywords

limb amputation / luminescence spectroscopy / necrosis / necrobiosis / limb gangrene / critical lower limb ischemia / limb mapping / precision surgery

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