Best Predictor
While certainly wound healing is a multi-factorial process, and as such each specific component must be addressed to ensure appropriate wound healing, if I had to pick ONE specific factor as a predictor for wound healing, I would argue that blood supply is most important.
Evaluation of perfusion both through noninvasive vascular studies such as TcPO2 as well as intraoperative appearance of the wound margins during debridement can all suggest the level at which an amputation should occur, and may suggest the need to attempt vascular intervention prior to wound closure or limb salvage. (At this point it is key to have developed a relationship with a vascular surgeon enlightened enough to attempt more distal bypass surgery and/or endovascular procedures below the ankle.)
While other factors, such as nutritional status or the presence of infection certainly play a major roll in wound healing, without a adequate perfusion, correcting these factors won't matter, because the cells won't get the the appropriate nutrition without the access via the circulatory system, nor will systemic antibiotics reach the area of infection in the absence of patent flow. In a sense, i feel that the blood supply is the rate limiting step --all other adjustments require it.
