Effect of leg elevation on the skin microcirculation in chronic venous insufficiency.
OBJECTIVE
Leg elevation is advised in the treatment of venous disease associated with edema. We have used laser Doppler fluxmetry to assess the effects of leg elevation on the skin microcirculation.


METHODS
Fifteen patients with lipodermatosclerosis caused by chronic venous insufficiency and 15 control subjects were studied. Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in control subjects. Laser Doppler flux, blood cell velocity, and concentration of moving blood cells were recorded with the subject lying in the supine position and after elevating the foot 30 cm above the heart level.


RESULTS
In subjects in the horizontal position, the resting laser Doppler flux was significantly higher in patients with lipodermatosclerosis than in control subjects (median difference 63 arbitrary units; 95% confidence interval: 36, 108). This difference was due to a higher concentration of moving blood cells in the patient group (median difference 6.5 arbitrary units; 95% confidence interval: 3.4, 9). The blood cell velocity was not statistically significant between the two groups. On leg elevation, there was a substantial increase in the laser Doppler flux in the patient group; the median percentage increase in flux was 45% (p < 0.01). This was due to an increase in blood cell velocity; the median percentage increase was 41% (p < 0.01). There was no corresponding change in the concentration of moving blood cells. The results in the control group showed a similar trend but have not reached statistical significance.


CONCLUSIONS
We conclude that limb elevation enhanced the microcirculatory flow velocity in liposclerotic skin of patients with chronic venous insufficiency.
Department of Surgery, University College London Medical School, United Kingdom.
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Abu-Own
J H
JH
Scurr
P D
PD
Coleridge Smith
D000368:Aged; D001783:Blood Flow Velocity; D002908:Chronic Disease; D016001:Confidence Intervals; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D007866:Leg / Q000098:blood supply*; D007868:Leg Dermatoses / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D012146:Rest; D012594:Scleroderma, Localized / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012867:Skin / Q000098:blood supply*; D016683:Supine Position; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*