Altered Postural Regulation of Foot Skin Oxygenation and Blood Flow in Patients with Type 2 Diabetes Mellitus

Iwase, Masanori; Imoto, Hideyuki; A, Murata; Nakamura, Udai; Nohara, Satoshi; Uchizono, Yuji; Iino, Kozo; Iida, Mitsuo

doi:10.1055/s-2007-960499

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…4,42,43 In concordance to these results, we also could not detect significant changes in capillary blood flow in either diabetic patients or in PAOD patients. Iwase et al 31 showed that transcutaneous oxygen pressure (TcPO 2 ) at the dorsal foot in patients with diabetes was reduced compared to healthy controls, whereas skin blood flow did not differ significantly. This is also in agreement with our results as we reported deteriorated cutaneous oxygen saturation with equivalent blood perfusion in patients with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Kabbani

Rotter

Busche

et al. 2013

Plastic and Reconstructive Surgery Global Open

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Background:Plastic and reconstructive surgeons are commonly faced with chronic ulcerations and consecutive wound infections of the feet as complications in patients with diabetes and/or peripheral arterial occlusive disease (PAOD). Microcirculatory changes seem to play an important role. However, the evaluation of functional changes in the soft tissue microcirculation at the plantar foot using combined Laser-Doppler and Photospectrometry System has not yet been performed in patients with DM or PAOD.Methods:A prospective, controlled cohort study was designed consisting of a total of 107 subjects allocated to 1 of 3 groups—group A: healthy subjects (57% males, 63.3 y); group B: patients with diabetes mellitus (DM) (53% males, 59.4 y); and group C: patients with PAOD (81% males, 66.1 y). Microcirculatory data were assessed using a combined Laser-Doppler and Photospectrometry System.Results:Global cutaneous oxygen saturation microcirculation at the plantar foot of healthy individuals was 8.4% higher than in patients with DM and 8.1% higher than in patients with PAOD (both P = 0.033). Patients with diabetes did not show significant differences in global cutaneous blood flow when compared with either healthy subjects or patients suffering from PAOD.Conclusions:Functional microcirculation at the plantar foot differs between healthy subjects and patients suffering from diabetes or PAOD of the same age. Patients with either diabetes or PAOD demonstrate deteriorated cutaneous oxygen saturation with equivalent blood perfusion at the plantar foot. More clinical studies have to be conducted to evaluate therapeutical methods that might ameliorate cutaneous oxygen saturation within diabetic foot disease and PAOD.

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Section: Discussionmentioning

confidence: 99%

Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Kabbani

Rotter

Busche

et al. 2013

Plastic and Reconstructive Surgery Global Open

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“…These abnormalities may initiate microvascular damage and contribute to the development of foot complications. The impaired veno-arteriolar reflex is found in both type 1 [45] and type 2 diabetes [28,44,46,47]. known that vascular endothelium plays an important role in controlling microvascular tone by synthesizing and releasing several vasodilator substances such as nitric oxide, prostacyclin, and endothelium-derived hyperpolarizing factor, and vasoconstrictor substances such as prostaglandins, angiotensin II, and endothelin [15,48].…”

Section: Local Sympathetic Veno-arteriolar Axon Reflexmentioning

confidence: 99%

Microvascular dysfunction in diabetic foot disease and ulceration

Chao

Cheing

2009

Diabetes Metabolism Res

166

129

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Diabetic foot disease and ulceration is a major complication that may lead to the amputation of the lower limbs. Microangiopathy may play a significant role in the pathogenesis of tissue breakdown in the diabetic foot. However, the precise mechanisms of this process remain unclear and poorly understood. Microvasculature in the skin is comprised of nutritive capillaries and thermoregulatory arteriovenous shunt flow. It is regulated through the complex interaction of neurogenic and neurovascular control. The interplay among endothelial dysfunction, impaired nerve axon reflex activities, and microvascular regulation in the diabetic patient results in the poor healing of wounds. Skin microvasculature undergoes both morphologic changes as well as functional deficits when parts of the body come under stress or injury. Two important theories that have been put forward to explain the abnormalities that have been observed are the haemodynamic hypothesis and capillary steal syndrome. With advances in medical technology, microvasculature can now be measured quantitatively. This article reviews the development of microvascular dysfunction in the diabetic foot and discusses how it may relate to the pathogenesis of diabetic foot problems and ulceration. Common methods for measuring skin microcirculation are also discussed.

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“…6 Such a vasoconstriction reflex response is impaired in people with diabetic neuropathy and ulceration. [7][8][9] The reduction or absence of effective precapillary vasoconstriction upon standing will expose the capillary bed to a high hydrostatic load, leading to edema and thickening of the capillary basement membrane. Very few studies have performed a quantitative assessment of the degree of foot swelling that occurs in a diabetic foot.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Chao

Zheng

Cheing

2012

Diabetes Technology & Therapeutics

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Background: Skin blood flow plays an important role in maintaining the health of the skin. The development of interstitial edema may impede oxygen diffusion to the skin. The aim of this study was to evaluate the association of skin blood flow and edema and epidermal thickness in the feet of people with and without diabetic neuropathy compared with a healthy control group. Subjects and Methods: Eighty-seven subjects (19 people with diabetic neuropathy and foot ulceration, 35 people with diabetes but without neuropathy, and 33 healthy controls without diabetes) participated in the study. High-frequency ultrasonography was used to measure the epidermal thickness and edema in papillary skin at the big toe as reflected by the thickness of the subepidermal low echogenic band (SLEB). The capillary nutritive blood flow was measured by the use of video capillaroscopy, and skin blood flux was monitored by laser Doppler flowmetry.Results: There was a 7.2% increase in epidermal thickness in those with diabetes but without neuropathy and a 16.5% decrease in people with diabetic neuropathy and foot ulceration compared with the healthy controls (all P < 0.05). The SLEB thickness increased in all subjects with diabetes to a greater degree in those with neuropathy and ulceration than in those without (64.7% vs. 11.8%, P < 0.001). Skin blood flux was shown to be higher in the diabetes groups than in the controls (all P < 0.05), but no significant differences were found in the resting nutritive capillary blood flow (P > 0.05). A significant negative correlation (P = 0.002, r = -0.366) was demonstrated between the SLEB and epidermal thickness at the pulp of the big toe, whereas no significant correlation was demonstrated between skin blood flow and epidermal thickness (all P > 0.05). Conclusions: An increase in subepidermal edema was demonstrated in people with diabetic neuropathy and ulceration, which may partly contribute to reduced epidermal thickness at the pulp of the big toe. This may subsequently lead to the breaking down of skin in the diabetic foot.

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Altered Postural Regulation of Foot Skin Oxygenation and Blood Flow in Patients with Type 2 Diabetes Mellitus

Abstract: The present study demonstrated the dissociated regulation of skin oxygenation and blood flow in response to leg dependency. Impaired postural vasoconstriction was associated with altered regulation of skin oxygenation probably due to sympathetic vascular dysfunction in diabetic patients.

Cited by 14 publications

References 14 publications

Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

Microvascular dysfunction in diabetic foot disease and ulceration

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

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