Hyperaemic changes in forearm skin perfusion and RBC concentration after increasing occlusion times.

Tissue occlusion and the hyperaemic response upon reperfusion can be used as a tool to assess microvascular function in various vascular diseases. Currently, laser Doppler flowmetry (LDF) is applied most often to measure hyperaemic responses. In this study, we have applied tissue viability imaging (TiVi) and LDF to measure the change in red blood cell concentration and perfusion in the skin after occlusions of the forearm with increasing duration. We have found that there is a strong correlation between the changes in perfusion and red blood cell (RBC) concentration during post-occlusive hyperaemia (perfusion: r=0.80; RBC concentration: r=0.94). This correlation increases with longer occlusion durations (1, 5 and 10min). Furthermore, for both perfusion and RBC concentration, the maximum responses (perfusion: r(2)=0.59; RBC concentration: r(2)=0.78) and the recovery times (perfusion: r(2)=0.62; RBC concentration: r(2)=0.91) increase linearly with the duration of the occlusion. Maximum responses and recovery times were more reproducible for RBC concentration (as measured with TiVi) than for perfusion (as measured with LDF). These results show that perfusion and RBC concentration are related during post-occlusive hyperaemia and that TiVi can be used as a tool in the assessment of hyperaemic responses that has advantages in terms of reproducibility, sensitivity and ease of use.

[1]  B. Duling,et al.  Multiple mechanisms of reactive hyperemia in arterioles of the hamster cheek pouch. , 1981, The American journal of physiology.

[2]  Folke Sjöberg,et al.  Sitting Pressure and Perfusion of Buttock Skin in Paraplegic and Tetraplegic Patients, and in Healthy Subjects: A Comparative Study , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[3]  D. Mitchell,et al.  Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques--part I. Non-invasive techniques. , 2009, The British journal of oral & maxillofacial surgery.

[4]  R. M. Belchamber,et al.  Non-invasive techniques , 1995 .

[5]  A. Halim,et al.  Method optimization on the use of postocclusive hyperemia model to assess microvascular function. , 2008, Clinical hemorheology and microcirculation.

[6]  M. Intaglietta,et al.  Contribution of anaerobic metabolism to reactive hyperemia in skeletal muscle. , 2007, American journal of physiology. Heart and circulatory physiology.

[7]  G. Nilsson,et al.  Comparison of tissue viability imaging and colorimetry: skin blanching , 2009, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[8]  M. Leahy,et al.  Sub‐epidermal imaging using polarized light spectroscopy for assessment of skin microcirculation , 2007, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[9]  A. Shore,et al.  The biological zero signal in laser doppler fluximetry – origins and practical implications , 1999, Pflügers Archiv.

[10]  I. Whitaker,et al.  Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques. , 2009, The British journal of oral & maxillofacial surgery.

[11]  Marie-Louise O'Connell,et al.  Tissue viability (TiVi) imaging: temporal effects of local occlusion studies in the volar forearm , 2009, Journal of biophotonics.

[12]  H. Hashimoto,et al.  Impaired microvascular vasodilator reserve in chronic cigarette smokers--a study of post-occlusive reactive hyperemia in the human finger. , 1993, Japanese circulation journal.

[13]  Gert Nilsson,et al.  Tissue viability imaging: microvascular response to vasoactive drugs induced by iontophoresis. , 2009, Microvascular research.

[14]  R. Nossal,et al.  Model for laser Doppler measurements of blood flow in tissue. , 1981, Applied optics.

[15]  Y. Aso,et al.  Relationship between post‐occlusive forearm skin reactive hyperaemia and vascular disease in patients with Type 2 diabetes—a novel index for detecting micro‐ and macrovascular dysfunction using laser Doppler flowmetry , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[16]  P. Werker,et al.  Advancements in Free Flap Monitoring in the Last Decade: A Critical Review , 2010, Plastic and reconstructive surgery.

[17]  S. Agewall,et al.  Evaluation of endothelial function using finger plethysmography , 2009, Clinical physiology and functional imaging.

[18]  E. Beinder,et al.  Skin Flux During Reactive Hyperemia and Local Hyperthermia in Patients With Preeclampsia , 2001, Obstetrics and gynecology.

[19]  Folke Sjöberg,et al.  Perfusion of buttock skin in healthy volunteers after long and short repetitive loading evaluated by laser Doppler perfusion imager , 2007, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[20]  Mohamed Elmandjra,et al.  Post-occlusive reactive hyperemia in patients with peripheral vascular disease. , 2004, Clinical hemorheology and microcirculation.

[21]  Cutaneous bioengineering instrumentation standardization: the Tissue Viability Imager , 2009, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[22]  D. Sheriff,et al.  Is there a threshold duration of vascular occlusion for hindlimb reactive hyperemia? , 2005, Journal of applied physiology.

[23]  A. Gardner,et al.  The influence of obesity on calf blood flow and vascular reactivity in older adults , 2007, Dynamic medicine : DM.

[24]  F. Verheugt,et al.  Alterations in the peripheral circulation in patients with mild heart failure. , 2001, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[25]  P. Ganz,et al.  Activation of ATP-sensitive potassium channels contributes to reactive hyperemia in humans. , 1996, The American journal of physiology.