Vascular assessment of microcirculation in lower limb wounds

Abstract

A good blood supply is paramount to initiate healing of lower limb wounds regardless of whether these are in an acute or a chronic phase, and it is vital that the method chosen for vascular assessment is accurate, user friendly and if possible non invasive. Several methods of vascular assessment are currently available for both clinical as well as research use. Included in this review are laser Doppler flowmetry and perfusion imaging with the utilisation of iontophoresis and reactive hyperaemia, laser speckle contrast imaging, photoplethysmography, thermal infra red imaging, transcutaneous oxygen tension as well as the ankle brachial pressure index and nailfold capillaroscopy. Although the techniques function in a variety of ways, the measurements offer an understanding of the role of microvasculature and endothelial function in the development of lower limb ulcers, as well as in wound assessment and the determination of the possibility of healing as an outcome of management strategies. This review outlines the techniques for assessment and given the important role microvasculature plays in the repair and healing of wounds, examines the available evidence for the role of the various measurements in this process.

Nursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries.