A study was undertaken to compare two new methods of capillary blood flow measurement, namely fluorescein flowmetry (FF) and laser Doppler flowmetry (LDF). The blood flow was measured in a pelvic pouch during its construction and in the completed ileoanal anastomosis in 12 patients. There was a high correlation between the two methods (correlation coefficient, 0.78) (p less than 0.01) when the blood flow was measured in the pelvic pouch. The correlation coefficient between the two methods for the difference between the blood flow in the pelvic pouch at the site of the planned anastomosis when the pouch resided in the abdomen and that in the completed ileoanal anastomosis was r = 0.99 (n = 12, p less than 0.001); the reduction amounted to 25% as measured by FF and 27% as measured by LDF (n = 12, p less than 0.01). All ileoanal anastomoses healed perfectly, the lowest FF and LDF values being 0.004 density units/sec and 0.3 V, respectively. The results indicate that either method can be considered for measuring capillary blood flow.
Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex and in the surrounding skin. Sixty-nine patients with invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a "lazy-S"-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two or three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (p < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.
It is not known to what extent the skin blood flow increases after vascular reconstruction in ischaemic limbs. Thus, a study was undertaken to measure skin blood flow, using the two techniques laser Doppler flowmetry and fluorescein flowmetry, before and after vascular reconstruction. The skin temperature was measured also. The plantar circulation was assessed in 14 patients (9 non-diabetics and 5 diabetics; mean age 65 years; range 47-80), with the patient in the supine position, 1-2 days before and 8-10 days after surgery. After vascular reconstruction the skin blood flow increased by 240% (P < 0.01) when measured by fluorescein flowmetry and by 148% (P < 0.01) when measured by laser Doppler flowmetry, and the skin temperature rose by 3.2 degrees C (P < 0.01). In the contralateral non-operated limb there was no significant change in skin blood flow as measured by the two methods. The results imply that after vascular reconstruction in ischaemic limbs the skin blood flow increases both in the superficial layer as determined by fluorescein flowmetry (which measures the blood flow down to 0.6 mm) and in deeper layers as determined by laser Doppler flowmetry (which measures flux down to 6 mm).
Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight-bearing pressure. The relationship between weight-bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm-2 or more in both diabetic and control subjects. Below 3 N cm-2 the blood flow was independent of weight-bearing pressure both in diabetic and control subjects (correlation coefficient r = -0.01 and -0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.
We have measured the plantar forefoot skin circulation by the uptake of sodium fluorescein (fluorescein flowmetry), 133Xe clearance and laser Doppler fluxmetry in 24 healthy subjects and correlated measurements under basal conditions and after provocation by alcohol intake and application of external heat. To assess the change in skin circulation between the initial measurement at rest and the second measurement after provocation, the coefficient of correlation (r) of the fluorescein flowmetry to the fast slope of the 133Xe elimination curve was 0.46 (p < 0.05), to the slow slope of the 133Xe elimination curve 0.66 (p < 0.001) and to laser Doppler fluxmetry 0.86 (p < 0.001). The coefficient of correlation (r) of the fluorescence appearance time to fluorescein flowmetry was 0.65 (p < 0.001), to the fast slope of the 133Xe elimination curve 0.14 (p = 0.42), to the slow slope of the 133Xe elimination curve 0.47 (p < 0.05) and to laser Doppler fluxmetry 0.63 (p < 0.00l). The uptake of sodium fluorescein as measured by fluorescein fluxmetry correlates well with both 133Xe clearance and laser Doppler fluxmetry in assessing a change in skin circulation in healthy humans. The fluorescence appearance time also correlates to the slow slope of the 133Xe elimination curve and to laser Doppler fluxmetry though to a lesser extent.
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