title: The correlation between three methods of skin perfusion pressure measurement: radionuclide washout, laser Doppler flow, and photoplethysmography.
abstract: The most accurate measurement of skin perfusion pressure is made with use of radioisotopic clearance techniques. We compared the skin perfusion pressure using radioisotope to the skin perfusion pressure measured simultaneously by placing laser Doppler and photoplethysmography probes within a transparent polyvinylchloride plastic blood pressure cuff in 13 subjects. A new device, which was created for this experiment, consisted of a plastic bladder into which light-emitting probes can be placed, so that the pressure applied to the skin was transmitted by the surface of the bladder, rather than by the surface of a rigid probe. The cuff was inflated to a supra-systolic pressure over the intradermal injection site of technetium Tc 99m, then deflated in 10 mm Hg decrements at 3-minute intervals. The pressures at which radioisotope clearance began, at which microcirculatory flow was detected by laser Doppler, and at which deflection of the photoplethysmography (DC mode) output occurred, were recorded as the skin perfusion pressure. The range of radioisotopic determined skin perfusion pressure was 0 to 100; skin perfusion pressure-laser Doppler was 0 to 100; and skin perfusion pressure-photoplethysmography was 60 to 100, with 7 of 13 limbs demonstrating no clear deflection point and thus an unobtainable skin perfusion pressure-photoplethysmography reading. Linear regression revealed a coefficient of correlation of 0.991 for skin perfusion pressure when the radioisotopic and laser Doppler methods were compared. Our study is not in agreement with previous reports of the successful determination of skin perfusion pressure with use of photoplethysmography. This may be due to differences in our technique when compared with previous reports of skin perfusion pressure-photoplethysmography determination.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Morristown Memorial Hospital, NJ 07962-1956.
authors.forename: L
authors.initials: L
authors.lastname: Malvezzi
authors.forename: J J
authors.initials: JJ
authors.lastname: Castronuovo
authors.forename: L C
authors.initials: LC
authors.lastname: Swayne
authors.forename: D
authors.initials: D
authors.lastname: Cone
authors.forename: J Z
authors.initials: JZ
authors.lastname: Trivino
mesh_terms: D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007834:Lasers; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D011877:Radionuclide Imaging / Q000379:methods; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply* / Q000000981:diagnostic imaging; D014463:Ultrasonography