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Skin microcirculation in patients with sequelae from local cold injuries
A Arvesen1, L Rosén, L P Eltvik
1Vascular Research Laboratory, Aker University Hospital, Oslo, Norway.
International Journal of Microcirculation, Clinical and Experimental
|November 1, 1994
Summary
Local cold injuries (LCI) impair cold tolerance by disrupting cold-induced vasodilation (CIVD) reflex mechanisms. This increases the risk of future cold injuries, even in unaffected limbs.
Area of Science:
- Physiology
- Dermatology
- Vascular Medicine
Background:
- Local cold injuries (LCI) can lead to long-term sequelae, including persistent cold intolerance.
- Understanding the underlying pathophysiology of these late effects is crucial for patient management and prevention.
- Previous military service involving cold exposure is a common cause of LCI in affected populations.
Purpose of the Study:
- To assess skin microcirculation and neurovascular reflex responses in patients with sequelae from LCI.
- To investigate the mechanisms behind impaired cold tolerance and delayed cold-induced vasodilation (CIVD) after LCI.
- To determine if LCI has generalized effects on microcirculation in unaffected extremities.
Main Methods:
- Laser Doppler fluxmetry, transcutaneous oxygen tension (TCpO2), and vital capillaroscopy were employed.
- Neurovascular reflexes were stimulated using deep inspiration, digital cuff occlusion, neck cooling, and cold water immersion (5°C and 15°C).
- Both affected and unaffected extremities were studied to identify localized and generalized effects.
Main Results:
- Cold-induced vasodilation (CIVD) was significantly delayed or absent in affected limbs during cold immersion.
- Affected limbs exhibited lower skin temperatures and delayed CIVD was also observed in unaffected feet of patients with prior hand injuries.
- While resting TCpO2 was decreased, key parameters like oxygen reappearance time and postocclusive reactive hyperemia remained normal; no capillary abnormalities were detected.
Conclusions:
- LCI induces significant disturbances in CIVD, leading to reduced cold tolerance and an elevated risk of re-injury.
- The findings suggest that neurophysiologic factors, particularly disturbances in central nervous system-mediated reflex mechanisms, are more critical than ischemic factors in LCI sequelae.
- Impaired reflex control of vascular responses to cold is a key mechanism in the long-term consequences of local cold injuries.