title: Vasodilatory capacity of the skin in venous disease and its relationship to transcutaneous oxygen tension.
abstract: Low transcutaneous oxygen tension (Ptc,O2) values in the supramalleolar skin of patients with venous disease are often reported. This measurement involves heating the skin to 43 degrees C to cause maximum vasodilatation and is valid only if liposclerotic and normal skin can vasodilate to the same degree. Forty-four limbs were studied, 15 with lipodermatosclerosis (LDS), 14 with uncomplicated varicose veins, and 15 controls. A Ptc,O2 electrode was modified to incorporate a laser Doppler probe. Laser Doppler flux was measured in the supramalleolar skin before and after local heating to 43 degrees C and the relative increase in flux was measured. The Ptc,O2 was then measured at the same site and on the chest. Vasodilatory capacity was expressed as the ratio of peak:basal laser Doppler flow, and the Ptc,O2 was expressed as a leg:chest ratio. Median laser Doppler flow was higher in limbs with LDS (median 67 mV) than in normal limbs (median 40 mV) (P less than 0.03). Ptc,O2 was higher in control limbs (median ratio 0.94) than in limbs with LDS (median 0.53) (P less than 0.006). The microcirculation in LDS had less capacity to vasodilate after heating (median factor of increase 5.4) than normal skin (median factor of increase 12.3) (P less than 0.001). A simple regression analysis was performed on all pairs of data, and revealed a correlation between Ptc,O2 and vasodilatory capacity (r = 0.524, P less than 0.001). The results indicate that low Ptc,O2 levels in venous disease reflect an inability of the microcirculation to increase its flow in response to local heating; inferences about the oxygen content of liposclerotic skin at normal temperatures cannot be drawn using this technique.
authors.affiliation: Department of Surgery, University College and Middlesex School of Medicine, Middlesex Hospital, London, UK.
authors.forename: T R
authors.initials: TR
authors.lastname: Cheatle
authors.forename: E C
authors.initials: EC
authors.lastname: Stibe
authors.forename: S K
authors.initials: SK
authors.lastname: Shami
authors.forename: J H
authors.initials: JH
authors.lastname: Scurr
authors.forename: P D
authors.initials: PD
authors.lastname: Coleridge Smith
mesh_terms: D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007834:Lasers; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D012594:Scleroderma, Localized / Q000503:physiopathology; D012867:Skin / Q000098:blood supply*; D014648:Varicose Veins / Q000378:metabolism / Q000503:physiopathology*; D014664:Vasodilation / Q000502:physiology*
chemical_list: D010100:Oxygen