A Review of Microvascular Measurements in Wound Healing

Abstract

The microcirculatory evaluation in patients affected by arteriopathic or venous ulcers is usually carried out using laser Doppler flowmetry, transcutaneous oxygen (transcutaneous pressure of oxygen, TcPO(2)), and carbon dioxide (transcutaneous pressure of carbon dioxide, TcPCO(2)) measurements and capillaroscopy. These techniques provide significant pathophysiologic and prognostic information. TcPO(2) and TcPCO(2) diagnose and classify the extent of arterial disease in the leg ulcers caused by arterial disease; the prognostic value is recognized, though doubts about its prognostic potential exist in the case of leg ulcer. Laser Doppler flowmetry is able to identify the first functional impairment in the early stages of the arterial disease and in the complicated venous insufficiency. Capillaroscopy gives us morphological and quantitative parameters of the capillary bed that is damaged in arteriopathic and venous ulcers; nevertheless, it does not provide us with definite prognostic indexes. Combining the 3 methods may contribute to yield objective measures in the clinical management of lower extremity ulcers.

Noninvasive Transcutaneous Monitoring in Long-Term Follow-Up of Patients With Thromboangiitis Obliterans Treated With Intravenous Iloprost

“…The reproducibility of LDF measurements has been reported. 23 Statistical analysis. Statistical analysis required the use of mixedeffect linear models and Dunnett test.…”

“…In addition, lower functional impairment recorded at forefoot level compared with the hallux is probably due to the presence of documented lower arteriovenous anastomoses in the forefoot, and these anastomoses constitute the greater part of the LDF signal recorded. 23 However, the smallest microcirculatory forefoot impairment was documented by the partial conservation of dependent VAR, which physiologically shows a reduced flow in orthostasis. Vice versa in the hallux, marked VAR alterations, in the passage from supine to dependent position, reflected in a mean increased signal, instead of reduced local flow.…”

Optical Imaging and Measurement of Angiogenesis

“…Tissue perfusion measurements can also be performed chronically as laser Doppler flowmetry has been used for clinical assessment of skin wound healing [130]. A comparison of laser Doppler and laser speckle contrast imaging of perfusion in human burn scars has clinically shown equivalence in the measurements produced by both techniques [131].…”

Effects of upper-limb exercise on lower-limb cutaneous microvascular function in post-surgical varicose-vein patients

“…Chronic venous disease is a common cause of lower-limb ulceration (Iabichella et al 2006). Several factors might affect tissue viability and susceptibility to ulceration, but the structural and functional integrity of the microcirculation to maintain blood flow, tissue oxygenation, and nutrient delivery might be particularly important (Iabichella et al 2006).…”

“…Several factors might affect tissue viability and susceptibility to ulceration, but the structural and functional integrity of the microcirculation to maintain blood flow, tissue oxygenation, and nutrient delivery might be particularly important (Iabichella et al 2006). Indeed, microcirculatory impairment is involved in all the hypotheses on ulcer pathophysiology (Iabichella et al 2006), the trophic tissue damage caused by vein insufficiency is preceded by the development of microvascular abnormalities (Iabichella et al 2006), and skin microvascular abnormalities are a risk factor for chronic ulceration in patients with varicose veins but no history of venous ulcer (Robertson et al 2009). Therefore, assessment of cutaneous microvascular function in patients with mild-to-moderate venous disease might be useful for identifying those at high risk of venous ulceration.…”