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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
PubMed
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.

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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.

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  • 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.