MORPHOLOGICAL-CHANGES IN THE SKIN MICROLYMPHATICS IN RECENTLY INJUREDPARAPLEGIC PATIENTS WITH ILIOFEMORAL VENOUS THROMBOSIS

Based on morphological features of the lymphatic microcirculation of t he skin from healthy subjects, and from paraplegic patients who had no evidence of ilio-femoral venous thrombosis (thromboembolic disease: T ED), the leg terminal lymphatic vessels from skin biopsies of five mal e paraplegic patients with acute traumatic spinal cord lesions and wit h documented TED were studied. Paraplegic patients with TED had lymph vessels with a dilated lumen surrounded by a rarefacted perivascular c onnective tissue characterized by dissociation and disruption of colla gen and elastic fibres. The lymphatic wall was generally attenuated an d some open junctions and channels delimited by endothelial protrusion s were observed. The venous outflow obstruction caused by deep venous thrombosis accompanied by the absence of ambulatory venous pressure in the paretic leg determines skin microlymphatic dilatation, lymph stas is and changes in the interstitial connective tissues. These alteratio ns may be considered to be the morphological aspect of the dystrophic alterations seen in the skin of legs from paraplegic patients with TED . The results are discussed in view of the correct rehabilitative medi cal treatment necessary, and adequate prophylaxis of TED.