Skin vascular resistance and skin perfusion pressure as predictors of healing of ischemic lesion of the lower limb: influences of diabetes mellitus, hypertension, and age.
An isotope washout technique that requires inexpensive equipment and is well tolerated by patients has been developed to measure skin perfusion pressure (SPP) and skin vascular resistance (SVR). The SPP is a measure of the severity of peripheral vascular disease and the SVR is an indicator of microangiopathy associated with diabetes mellitus and hypertension. This test has been applied to 87 patients who had ischemic lesions of the lower limb. Fourty-four patients had lesions that healed with local treatment while the other 43 required major surgery. The presence of diabetes, hypertension, and old age reduced the likelihood of healing. Similarly if the SPP less than 40 mm Hg, only 18% of patients' lesions healed. If the SPP lay between 40 and 50 mm Hg and the SVR less than 1000 U, 67% of lesions healed. However, if the SPP was between 40 and 50 mm Hg and the SVR greater than 1000 U, no lesions healed. If the SPP greater than 50 mm Hg and SVR less than 1000 U, 83% of lesions healed, where as if the SVR greater than 1000 U, healing occurred in only 23% of lesions. This test can be used to predict the likelihood of healing of ischemic lesions of the lower leg, thus rationalizing their management. The importance of microangiopathy is also demonstrated.
D000328:Adult; D000367:Age Factors; D000368:Aged; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007511:Ischemia / Q000503:physiopathology*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000098:blood supply*; D014655:Vascular Resistance; D014945:Wound Healing