Microangiopathy of split-skin grafts in venous ulcers.
BACKGROUND
In patients with chronic venous insufficiency, microangiopathy of blood and lymph capillaries caused by venous hypertension plays a major role in the development of venous ulceration. Conservative treatment of venous leg ulcers often fails, and split-skin grafting is sometimes performed.


OBJECTIVE
To evaluate the microcirculation and especially the regeneration and function of lymphatic vessels in skin grafts in patients with chronic venous insufficiency.


METHODS
The microcirculation of 15 split-skin grafts was studied by fluorescence microlymphography and measurement of transcutaneous oxygen tension (tcpO2) in 13 patients.


RESULTS
The mean age of the skin grafts was 70.9 months. In only two skin grafts were a few intact lymph meshes found. In all other cases, only fragments of lymphatic capillaries have been detected. In seven skin grafts, cutaneous backflow of dye through insufficient deeper lymph channels was observed. The maximal spread of the dye in the lymphatic network was increased in the skin grafts (17.6 +/- 22.9 mm). The mean value of tcpO2 was only 27.1 +/- 18.1 mm Hg.


CONCLUSIONS
In split-skin grafts of patients with venous ulcers, severe microcirculatory changes are present and characterized by hypoxia and abnormal regeneration and function of lymphatic vessels.
Department of Internal Medicine, Division of Angiology, University Hospital, Zurich, Switzerland. beatrice.amann@usz.ch
Beatrice R
BR
Amann-Vesti
Corinne
C
Ruesch
Gabriele
G
Gitzelmann
Juerg
J
Hafner
Renate
R
Koppensteiner
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D016038:Skin Transplantation / Q000379:methods; D014647:Varicose Ulcer / Q000601:surgery*