The effect of different positions on lower limbs skin perfusion pressure

Abstract

We have encountered situations of patients with critical limb ischemia accompanied by pain at rest and necrosis, who hang their legs down from the bed during sleep. This lower limb position is known to be a natural position, which reduces pain in the lower extremity induced by ischemia. However, the effect of this position on blood flow of the lower extremity is poorly understood. We studied whether measurements of skin perfusion pressure (SPP) changes by leg position and the difference between healthy adults and patients with critical limb ischemia. The subjects of this study were 10 healthy adults and 11 patients with critical limb ischemia. Patients with critical limb ischemia, including both dorsum of foot and plantar of foot, having SPP of lower limbs of less than 40 mmHg (supine position) were the object of this study. SPP was measured on four positions (supine position, lower limbs elevation position, sitting position, and reclining bed elevation of 20° position). In sitting position, both the number of healthy adults and critical patients show significant increases in SPP compared with the other three positions. These results suggest that sitting position is effective to keep good blood stream of lower limbs not only in healthy adults but also in patients with critical limb ischemia. However, an appropriate leg position should not have lower limbs hang downwards for long periods time because edema is caused by the fall in venous return in lower limbs, and the wound healing is prolonged.Our clinical research could be more useful in the future, particularly in developing countries, for surgeons managing wounds in leg and foot and preserving ischemic limbs.

The Effect of Upper Limb Elevation on Limb Edema and Central Venous Pressure in ICU Patients

“…Kawasaki et al found that the circulation of lower limbs is better in hanged positions (in a lower level than heart), but staying for a long time in this position causes venous congestion, edema and delayed wound healing (11). Our study indicated that 30-degree elevation of upper limb could reduce the interstitium fluid and edema.…”

“…They concluded that in sitting position and appropriate leg position, skin perfusion pressure was increased significantly compared with other positions in both healthy adults and critical patients. These results suggest that sitting position is effective to keep an appropriate blood stream of lower limbs not only in healthy adults but also in patients with critical limb ischemia (11). Therefore, it seems that limb elevation could be effective to prevent and reduce limb edema.…”

The application of wireless near infrared spectroscopy on detecting peripheral circulation in patients with diabetes foot ulcer when doing Buerger's exercise

“…[14]. They found that SPP was increased significantly in sitting position in both critical limb ischemia and healthy control groups [14]. In Figure 2, we discovered that HbO2 and HbT concentrations were changed in a similar trend between three groups at each stage of Buerger's exercises.…”

“…The amount of HbT (The sum of HbO2anddeoxy-Hb) in a given area of tissue could indirectly represent the blood flow of the peripheral tissue in our unique apparatus. [14]. They found that SPP was increased significantly in sitting position in both critical limb ischemia and healthy control groups [14].…”

“…In 2013, Kawasaki et al demonstrated the relationship between positional change and peripheral circulation by measuring different SPP levels in four positions (supine, lower limbs elevation, sitting, and reclining bed of 20° elevation) . They found that SPP was increased significantly in sitting position in both critical limb ischemia and healthy control groups .…”