Microcirculation in venous leg ulcers during healing: Prognostic impact

The aim of this study was to determine the extent to which cutaneous microa ngiopathy changes or improves during healing. Does the healing process depe nd on the improvement of cutaneous blood flow? To determine this, we measur ed capillary density and transcutaneous oxygen tension at regular intervals . Ten patients were examined-four women and sb men aged 57.3+/-9.7 (mean+/- SD) with chronic venous insufficiency (CVI) stage IU according to Widmer, a n ulcer area of 7.9+/-11.2 cm(2), and a mean duration of wound healing of 1 7.9+/-31.9 weeks. The patients were subdivided into two groups according to the duration of healing (<6 weeks = fast healing, >6 weeks = delayed heali ng). Complete healing was accompanied by an increase in capillary density f rom 7.1+/-6.4 to 16.0+/-10.7 capillaries/mm(2) (n.s) in the ulcer area and from 30.2+/-9.6 to 40.51+/-16.0 capillaries/mm(2) (ns) at the border of the ulcer. During the first two weeks of therapy, fast healing was accompanied by an increase in capillary density from 26.4+/-6.4 to 41.0+/-17.6 capilla ries/mm(2) at the ulcer edge and from 7.4+/-7.7 to 12.6+/-8.8 capillaries/m m(2) in the ulcer itself. Capillary density increased in the delayed healin g group from 34.0+/-11.4 to 35.8+/-10.3 capillaries/mm(2) at the herder and from 6.8+/-5.6 to 8.4+/-8.6 capillaries/mm(2) in the ulcer. Fast healing w as characterized by a higher initial tcPO(2) than in the group with delayed healing. In conclusion, we can say that venous leg ulcers heal if nutritiv e circulation improves. If the nutritive blood flow, given here as capillar y density and tcPO(2), improves during the first two weeks of treatment, th en venous leg ulcers tend to heal fast. Thus, these parameters are revealed to have prognostic value for the healing of venous ulcers.