W. Jochmann et al., POSTOCCLUSIVE REACTIVE HYPEREMIA AND POSTURAL VASOCONSTRICTION IN DIFFERENT KINDS OF LEG ULCERS - INVESTIGATIONS WITH LASER-DOPPLER, VASA, 22(4), 1993, pp. 306-315
Laser-Doppler fluxmetry was performed in 42 patients with leg ulcers (
18 venous, 8 arterial, 12 diabetic-arteriolar and 4 mixed arterio-veno
us) and in 9 healthy controls. Using a bipolar probe measurement was c
arried out at the ulcer border and on the dorsum of the foot in the su
pine and in the sitting position. Reactive hyperemia after three minut
e arterial occlusion was produced in both body-positions. In every ulc
er-group resting and peak fluxes showed a statistically significant in
crease in the ulcer region as compared to normal skin of the lower leg
in the control group, the quotient between peak and resting flux (<<r
eactive hyperemia index>>) RHI) being significantly lower. The RHI val
ues for four ulcer-patients with a dramatic detioration worsening eigh
t months later were close to one, while the unchanged and improved cas
es showed median values above 1,2. Sitting up was followed by a decrea
se of flux in all ulcer-groups as well as in the control group. On the
dorsum of the foot there was an increase of the laser Doppler flux in
patients with arterial occlusive disease, i.e. in the group with arte
rial and mixed ulcers. This study shows that the kind of microcirculat
ory flow damage is not different in various causes of ulcerations. The
reduced reactive hyperemic response compared to the increased resting
fluxes (amount of RHI-decrease) might be a useful predictor for heali
ng or non-healing of the ulcer.