SKIN MICROVASCULAR ARCHITECTURE AND PERFUSION STUDIED IN HUMAN POSTMASTECTOMY EDEMA BY INTRAVITAL VIDEO-CAPILLAROSCOPY

Breast cancer treatment often causes chronic arm oedema. Oedema depend s on the balance between microvascular filtration and lymph drainage, but little is known about the microvessels in postmastectomy oedema (P MO). We investigated cutaneous capillary density in PMO, since capilla ry density is one of the factors influencing fluid load on the lymphat ic system. Video-capillaroscopy allows the skin microcirculation to be examined in vivo and recorded for later analysis. Patient arm volumes , measured optoelectronically, increased by 30 +/- 13%. The forearm sk in of each arm was examined in 7 normal subjects (mean age 22 years) a nd 15 PMO patients (mean age 61 years). Native capillaroscopy was foun d to underestimate capillary density. Venous congestion increased the number of capillaries detected by native capillaroscopy by 26-28%. Flu orescein detected 19-27% more capillaries than native capillaroscopy. Using fluorescein, no significant difference in mean capillary density was found between the right (50 mm(-2)) and left (48 mm(-2)) arms of normal subjects (p = 0.53). Surprisingly, cutaneous capillary density in the swollen arm (33 mm(-2)) was not significantly less than in nons wollen arms (35 mm(-2)) of patients, despite a mean 14% increase in sk in area. Capillary density decreased significantly with age. Relative to the volume and area changes, the density results indicated that cut aneous neovascularization had occurred in the swollen arm.