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The aim of this study was to investigate the breast lymph circulation and skin blood circulation after radiotherapy and breast conservation. In 23 patients who had undergone lumpectomy for breast cancer (mean age 58 years, range 44-75) and 12 patients with lumpectomy for benign lesions (mean age 51 years, range 33-72), lymph circulation in the breast was measured by 99mTc-nanocolloid clearance and skin circulation by Laser Doppler Fluxmetry (LDF). Measurements were made 2-5 years after radiotherapy (50 Gy) in the former group and at a corresponding time in the latter. The lymph circulation was measured 2 cm above and medial or lateral to the areolar border in the quadrant not operated on for carcinoma. Skin circulation was measured at corresponding sites. The lymph circulation expressed as the ratio of 99mTc-nanocolloid clearance in the operated irradiated to that in the non-operated (radiation 2-4 Gy) breast was 2.33 (2.66) (median, interquartile range) (p value 0.01) and the skin circulation ratio over the corresponding area was 0.92 (0.21). Corresponding ratios in the non-radiotherapy group were 2.07 (1.96) (p value 0.03) and 1.04 (0.18) respectively. Compared with the control breast (i.e., the non-operated non-irradiated breast), there was a 4-fold increase in lymph flow in the operated, irradiated breast, a 2.5-fold increase in the contralateral non-operated (2-4 Gy) breast and a 1.5-fold increase in the operated non-irradiated breast. Radiotherapy after breast conservation surgery leads to increased long-term changes in basal lymph circulation and smaller increases in lymph flow in the contralateral breast receiving 2-4 Gy and after surgery. If maximal lymph transport capacity is unchanged, edema may be more likely in this circumstance of reduced lymphatic transport reserve.

The skin circulation was measured in 43 breast cancer patients following subcutaneous mastectomy and immediate reconstruction with a prosthesis, at least 1 year after radiotherapy (46 Gy) following surgery (19 patients) or if no radiotherapy was given, at least 1 year postoperatively (24 patients). The skin circulation was measured by laser Doppler fluxmetry (LDF) and fluorescein flowmetry within three areas: 2 cm above the border of the areola, within the nipple-areola complex, and 2 cm below the border of the areola. The results show that there was no reduction in skin circulation. On the contrary LDF and fluorescein flowmetry showed in the operated breast an increased circulation in the nipple-areola complex in the irradiated breast compared with the non-irradiated by 26% and 30%, respectively (P < 0.05). The results indicate that radiotherapy following subcutaneous mastectomy and immediate reconstruction with a prosthesis does not lead to long-term reduction in basal skin circulation in the breast.

It is not known whether the skin circulation is altered in the long term by radiotherapy following breast conservative surgery. The skin circulation in the breast was therefore measured in 24 breast cancer patients (mean age 57 years; range 40-76), one year after radiotherapy (50 Gy) following lumpectomy. None of the patients showed any persistent redness of the skin. The skin circulation was measured using laser Doppler fluxmetry (LDF) and fluorescein flowmetry within three areas: 2 cm above the border of the areola (position 1), within the nipple areola complex (position 2) and 2 cm below the border of the areola (position 3). It was found that when measured with LDF, the skin circulation expressed as the ratio of operated irradiated to non-operated non-irradiated breast was 0.99 in position 1, 1.07 in position 2 and 0.91 in position 3; and when measured by fluorescein flowmetry, 1.00 in position 1, 1.08 in position 2 and 1.00 in position 3. The results indicate that radiotherapy following breast conservative surgery does not lead to long-term changes in basal skin circulation in the breast.

We have measured the plantar forefoot skin circulation by the uptake of sodium fluorescein (fluorescein flowmetry), 133Xe clearance and laser Doppler fluxmetry in 24 healthy subjects and correlated measurements under basal conditions and after provocation by alcohol intake and application of external heat. To assess the change in skin circulation between the initial measurement at rest and the second measurement after provocation, the coefficient of correlation (r) of the fluorescein flowmetry to the fast slope of the 133Xe elimination curve was 0.46 (p < 0.05), to the slow slope of the 133Xe elimination curve 0.66 (p < 0.001) and to laser Doppler fluxmetry 0.86 (p < 0.001). The coefficient of correlation (r) of the fluorescence appearance time to fluorescein flowmetry was 0.65 (p < 0.001), to the fast slope of the 133Xe elimination curve 0.14 (p = 0.42), to the slow slope of the 133Xe elimination curve 0.47 (p < 0.05) and to laser Doppler fluxmetry 0.63 (p < 0.001). The uptake of sodium fluorescein as measured by fluorescein fluxmetry correlates well with both 133Xe clearance and laser Doppler fluxmetry in assessing a change in skin circulation in healthy humans. The fluorescence appearance time also correlates to the slow slope of the 133Xe elimination curve and to laser Doppler fluxmetry though to a lesser extent.

Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex and in the surrounding skin. Sixty-nine patients with invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a "lazy-S"-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two or three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (p < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.

The question of whether alcohol intake increases skin circulation is controversial. The study described here was undertaken to examine the effect on skin circulation and skin temperature in ischaemic limbs of exposure to external heat, and of alcohol intake together with such exposure. Fourteen patients with occlusive arterial disease, mean age of 65 years (range 47-80), underwent measurements of blood flow by laser Doppler flowmetry (LDF) and of skin temperature 1-2 days before and 8-10 days after vascular reconstruction. LDF and skin temperature were measured in the plantar region of the mid-forefoot with the subject supine. After 30 min of exposure to external heat, the measurements were repeated. Each subject then drank 15 ml of 50% alcohol and after a further 30 min of heat exposure the same measurements were performed again. Similarly, fourteen healthy subjects, mean age 33 years (range 21-43), were studied. In the patients there was no increase in skin blood flow or skin temperature after heat exposure alone or after combined heat exposure and alcohol intake, either before or after vascular reconstruction. In the healthy subjects LDF showed a 126% increase (P < 0.01) in skin blood flow after 30 min of exposure to external heat and a further increase by 81% after alcohol intake and an additional 30 min of heat exposure (P < 0.01). The corresponding increases in skin temperature were 3.0 degrees C (P < 0.05) and 2.9 degrees C (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Elderly subjects are prone to develop pressure sores over the sacrum area mainly due to external pressure and shear effects which negatively affect the skin microcirculation. The aim of the study described here was to measure skin microcirculatory and thermal changes in twelve elderly patients with an early stage of pressure sore and in ten elderly subjects without pressure sore. The total skin microcirculation at a damaged risk area, the sacrum, and a reference area of undamaged skin over the gluteal region, was evaluated using the laser Doppler fluxmetry. The nutritive transport of small solutes, characterized by the transcapillary exchange of sodium fluorescein, was evaluated using the fluorescein flowmetry technique. The skin temperature was measured with a thermoelement. The skin microcirculation at the area with an early stage of pressure sore was significantly higher than at undamaged skin as measured by both techniques. The total microcirculatory blood flow increased > 16 times (P < 0.001) and the nutritive transport approximately 5 times (P < 0.01) compared to the reference value, and the calculated blood flow of subpapillary tissue layers increased 17-19 times (P < 0.001). However, the skin temperatures in damaged and undamaged skin did not differ significantly. These results show an increased skin microcirculation in the early stage of pressure sores but no increase in skin temperature. The more strongly increased skin blood flow in subpapillary tissue layers effectively conducts away the heat caused by the damage and the increased metabolic activity.

It is not known to what extent the skin blood flow increases after vascular reconstruction in ischaemic limbs. Thus, a study was undertaken to measure skin blood flow, using the two techniques laser Doppler flowmetry and fluorescein flowmetry, before and after vascular reconstruction. The skin temperature was measured also. The plantar circulation was assessed in 14 patients (9 non-diabetics and 5 diabetics; mean age 65 years; range 47-80), with the patient in the supine position, 1-2 days before and 8-10 days after surgery. After vascular reconstruction the skin blood flow increased by 240% (P < 0.01) when measured by fluorescein flowmetry and by 148% (P < 0.01) when measured by laser Doppler flowmetry, and the skin temperature rose by 3.2 degrees C (P < 0.01). In the contralateral non-operated limb there was no significant change in skin blood flow as measured by the two methods. The results imply that after vascular reconstruction in ischaemic limbs the skin blood flow increases both in the superficial layer as determined by fluorescein flowmetry (which measures the blood flow down to 0.6 mm) and in deeper layers as determined by laser Doppler flowmetry (which measures flux down to 6 mm).

Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight-bearing pressure. The relationship between weight-bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm-2 or more in both diabetic and control subjects. Below 3 N cm-2 the blood flow was independent of weight-bearing pressure both in diabetic and control subjects (correlation coefficient r = -0.01 and -0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.

Avascular necrosis of the nipple is a serious complication of reduction mammaplasty with nipple transposition. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 14 patients undergoing a reduction mammaplasty according to the method of Strömbeck, the skin circulation was measured in 25 breasts with laser doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 204.4 +/- 31.0% of the preoperative value (100%) (mean +/- SEM, p less than 0.01). After the upper and lower glandular resection the circulation was reduced to 90.7 +/- 12.3% of the preoperative value. The division of the lateral pedicle did not affect the circulation. After the skin had been sutured, the circulation was 71.5 +/- 9.1% of the preoperative value (p less than 0.01). One to four days postoperatively the circulation was 100.3 +/- 13.2% of the preoperative value. At FF uniform fluorescence was observed in the nipple postoperatively in all patients but two, in whom avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the Strömbeck method is adequate and that it is safe to divide the lateral dermal pedicle.