Die Wirkung der Kompressions-therapie auf die lokale Mikrozirkulation und Histomorphologie beim Ulcus cruris venosum

A. A. Altintas; B. Gehl; M. C. Aust; M. Meyer-Marcotty; M. A. Altintas

doi:10.1055/s-0037-1621698

Phlebologie, Inhaltsverzeichnis

Phlebologie 2011; 40(01): 9-14
DOI: 10.1055/s-0037-1621698

Originalarbeiten

Schattauer GmbH

Die Wirkung der Kompressions-therapie auf die lokale Mikrozirkulation und Histomorphologie beim Ulcus cruris venosum

Impact of compression therapy on local microcirculation and histomorphology in venous leg ulcer

A. A. Altintas

¹Plastische, Hand- und Wiederherstellungschirurgie, Universität Essen, Essen

,

B. Gehl

¹Plastische, Hand- und Wiederherstellungschirurgie, Universität Essen, Essen

,

M. C. Aust

²Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover

,

M. Meyer-Marcotty

²Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover

,

M. A. Altintas

²Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover

› Institutsangaben

Abstract

Zusammenfassung

Hintergrund: Die Wirkung der Kompressionstherapie auf die lokale Mikrozirkulation und Histomorphologie ist bisher nicht ausreichend belegt. Die konfokale Laser-Scanning-Mikroskopie (KLSM) ermöglicht eine in-vivo-Untersuchung der menschlichen Haut auf zellulärer Ebene.

Methode: Neunzehn Patienten mit Ulcus cruris venosum wurden folgenden Therapien zugeführt. Gruppe A: medizinische Kompressionstherapie, inaktive Wundauflage; Gruppe B: inaktive Wundauflage. Vor und 4 Wochen nach Therapiebeginn wurden folgende Parameter mittels KLSM evaluiert: zellulärer Blutfluss, Epidermisdicke, epidermale Zellgrößen, Quantität von Entzündungszellen.

Ergebnisse: In Gruppe A stieg nach vierwöchiger Kompressionstherapie der zelluläre Blutfluss signifikant an, in Gruppe B nur insignifikant. Die Epidermisdicke nahm in Gruppe A mehr ab als in Gruppe B. Die epidermalen Zellen veränderten sich in beiden Gruppen nur insignifikant. Die Quantität der Entzündungszellen nahm in Gruppe A von massiv auf vereinzelt und in Gruppe B von massiv auf vermehrt ab.

Conclusio: Mit der KLSM konnte die positive Wirkung der medizinischen Kompressionstherapie auf die lokale Mikrozirkulation und His-tomorphologie beim Ulcus cruris venosum nachgewiesen werden.

Summary

Background: The impact of compression therapy in the most severe outcome of chronic venous insufficiency on microcirculation and his-tomorphology is widely unknown. In vivo Confocal Laser-Scanning-Microscopy (CLSM) enables insight in human skin on cellular and sub-cellular levels. In this study, the impact of compression therapy on local micromorphology in venous leg ulcer was evaluated using CLSM.

Methods: Nineteen patients with chronic venous leg ulcer (ulcer size: 1 to 10 cm) were divided in two groups. Group A was treated with compression therapy and inactive wound dressing (4 m, 8 f, aged 68.4 years, BMI 26.9); Group B was treated solely with inactive wound dressing (2 m, 5 f, aged 64.2 years, BMI 28.1). Prior to start (control) and four weeks subsequently specific treatment in addition to ulcer size the following parameters were evalu- ated using CLSM (Vivascope1500^®, Lucid Inc, Rochester, New York; USA): individual blood cell flow (quantity of transcapillary blood cells flow), epidermal thickness, epidermal cell size, and quantity of inflammatory cells.

Results: In Group A control ulcer size was 32.4 cm² (37.2 cm²; Group B) and decreased significantly to 8.2 cm² (28.1 cm²; Group B, P<0.05) following four week therapy. In Group A blood cell flow was 40.04 ± 4.62/min (control) and increased up to 61.40 ± 5.16/min (P<0.05) subsequently compression therapy. In Group B control blood cell flow was 38.92 ± 6.80/min and increased slightly up to 42.80 ± 5.96/min (P>0.05). The epidermal thickness was found to be 69.10 ± 5.41 μm (control) and decreased significantly to 49.21 ± 4.60 μm in Group A. In Group B epidermal thickness was 71.48 ± 6.94 μm in controls and decreased slightly to 60.11 ± 5.16 μm. In both groups the epidermal cell size differ insignificantly (Group A 862.27 ± 42.96 μm² vs. 839.25 ± 61.13 μm²; Group B 870.04 ± 52.43 μm² vs. 852.73 ± 4.80 μm², P>0.05). The quantity of inflammatory cells decreased following specific therapy in both groups from massive to less in Group A, and in Group B from massive to more.

Conclusion: For the first time, CLSM demonstrated the positive impact of compression therapy in chronic venous leg ulcer on local microcirculation and histomorphology in vivo on cellular level.

Schlüsselwörter

Mikrozirkulation - Histomorphologie - in-vivo-Untersuchung - Mikroskopie

Keywords

Microcirculation - Histomorphology - in vivo-Imaging - Microscopy

Volltext

Referenzen

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