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Heterogeneous blood flow response in the foot on dependency, assessed by laser Doppler perfusion imaging
Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
1997 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 159, no 2, 101-106 p.Article in journal (Refereed) Published
Abstract [en]

The exact nature of the decrease in foot skin blood flow seen after a change in posture remains unsettled. This mechanism has previously been examined by non-invasive techniques such as the laser Doppler perfusion monitor (laser Doppler flowmetry). Taking into account the shortcomings of laser Doppler perfusion monitoring when applied to the determination of skin blood flow, which normally shows substantial heterogeneity, we have applied an emerging technology, the laser Doppler perfusion imager (LDPI). This technique provides a more comprehensive picture of the blood flow distribution in the skin, as it maps skin blood flow over a surface area (120×120 mm, 4096 measurement sites). It was used to examine if the reduction in tissue perfusion or the alterations in flow distributions seen after a change in posture (supine to dependency) could be fully explained by an increase in venous pressure (venous stasis of 50 mmHg) or if the data suggest a complementary mechanism.

Skin blood flow of the forefoot decreased from 0.60 V (volt) (median) during rest to 0.40 and 0.38 V during venous stasis and dependency, respectively. Although almost identical median values were obtained during stasis and dependency, the flow distributions were different, with a loss of high flow values during venous stasis. Biological zero was 0.24 V.

As the LDPI technique readily records skin perfusion during variations in venous stasis and posture, as well as information on flow distribution changes, it appears promising for future application in stimuli-response studies of skin blood flow. The difference in flow distribution seen between increased venous pressure and dependency suggests an additive regulatory mechanism to the veni-vasomotor reflex during a change in posture.

Place, publisher, year, edition, pages
1997. Vol. 159, no 2, 101-106 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81118DOI: 10.1046/j.1365-201X.1997.587345000.xOAI: oai:DiVA.org:liu-81118DiVA: diva2:550605
Available from: 2012-09-07 Created: 2012-09-07 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Regulation of Microvascular Blood Flow: a clinical and experimental study based on laser Doppler perfusion imaging
Open this publication in new window or tab >>Regulation of Microvascular Blood Flow: a clinical and experimental study based on laser Doppler perfusion imaging
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Local blood flow reflexes in the foot skin of healthy controls and in young diabetic patients with or without nerve dysfunction have been studied using laser Doppler perfusion imaging (LDPI). A neurophysiological follow-up study on nerve dysfunction is presented as a complerhent to the work on blood flow regulation in the young diabetics.

An enhanced high-resolution LDPI (EHR-LDPI), intended for visualization and interpretation of flow dynamics in separate microvessels, has been adapted and evaluated in in vitro tube models and in an in vivo tissue model (hamster cheek pouch). By focusing the laser beam to 40 µm in the focal plane and reducing the step length to 25 µm, full format images (4096 measurement sites) of microvascular tissue areas as small as 1,5 x 1,5 mm were created.

The objectives of the work were to study if the vasoconstrictor response seen during change in posture is a mechanism elicited by a rise in venous pressure, but also to investigate if young diabetic patients with nerve dysfunction have an impairment in the local regulation of foot skin blood flow (postural vasoconstriction and hyperemic response) compared to diabetics without nerve dysfunction. An additional aim was to elucidate whether abnormal nerve conduction is retarded or even prevented by tight metabolic control in patients with type 1 diabetes mellitus.

The experimental studies aimed to improve the resolution of the EHR-LDPI system, to evaluate the system flow response in an in vitro model and to evaluate the performance, the limitations and the future potentials by studying flow dynamics in a tissue containing separate microvessels. It was concluded that:

(1) The LDPI recorded skin perfusion during variations in venous stasis and posture, adding information on flow distribution changes. The difference in flow distribution seen suggested an additive regulatory mechanism to a venoarteriolar reflex during change in posture.

(2) Subclinical nerve conduction defects were more common than microvascular abnormalities as measured by LDPI in the present models in young diabetic patients. Although, no signs of established retinopathy or nephropathy in this patient group, resting skin blood flow abnormalities were present, and these findings were related to high HbA1c-levels.

(3) Tight longwterm metabolic control, with HbA1c values less than 6,5%, could retard nerve dysfunction in patients with type 1 diabetes mellitus and a mean disease duration of 12 years.

(4) Using EHR-LDPI a decrease in signal level was obtained as the tube diameter increased, although the algorithm scaled linearly with velocity and was found not to be sensitive to hematocrit variations. Individual microvessel diameters could be estimated, which on average resulted in a difference of 11 µm compared to microscopic measurements.

(5) A dynamic overview of the vascular tree with volumetric flow estimate as well as RBC velocities of separate vessels was obtained. The need for further focusing of the beam and reduction of the step length appeared to be important tasks to solve in order to get a more accurate vessel diameter determination and to refine the volumetric flow estimate.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 683
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27484 (URN)12138 (Local ID)91-7219-977-6 (ISBN)12138 (Archive number)12138 (OAI)
Public defence
2001-06-01, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-07Bibliographically approved

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Thulesius, OlavSjöberg, Folke

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Plastic Surgery, Hand Surgery and BurnsFaculty of Health SciencesClinical PhysiologyDepartment of Biomedical EngineeringAnesthesiology
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