Effects of low-intensity pulsed ultrasound on soft tissue micro-circulation in the foot

Kösters, Anna Katharina; Ganse, Bergita; Gueorguiev, Boyko; Klos, Kajetan; Modabber, Ali; Nebelung, Sven; Kim, Bong-Sung; Knobe, Matthias

doi:10.1007/s00264-017-3574-3

Cited by 23 publications

(15 citation statements)

References 28 publications

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“…Another shortcoming is the low number of smokers and diabetics in the patient collective. In addition, laser-Doppler spectrophotometry is known to show substantial spatial, temporal, and intra-individual variation, which is a known weakness of this method (Sommer et al, 2013; Kösters et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, differences in microcirculation were found between surgical approaches in spine surgery, i.e., less impairment of microcirculation in minimally invasive surgery of the spine compared to open surgery (Ganse et al, 2017). Distinctions in microcirculation between approaches in Achilles tendon surgery in healthy subjects (Klos et al, 2018), gender differences in skin microcirculation over the calcaneus (Carow et al, 2018) and effects of pulsed ultrasound therapy in the foot were published (Kösters et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

et al. 2019

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Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO 2 ), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO 2 , Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO 2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO 2 , Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO 2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

et al. 2019

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“…The O2C device as a tool for noninvasive detection of hemoglobin saturation and blood flow using laser Doppler technique and white light spectroscopy allows for valid and reproducible quantitative determination of microcirculatory parameters [ 19 – 24 ], as well as identification of possible influencing factors in healthy subjects [ 23 , 25 ]. Currently, O2C studies have provided evidence for altered soft tissue microcirculation after peripheral artery occlusive disease [ 26 ] as well as for individual healing tendencies depending on the microcirculatory parameters in patients with burns [ 27 , 28 ] and chronic diabetic foot ulcers [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, we cannot estimate microcirculation in a trauma situation, which can be different. Further studies are necessary to clarify the question of gender-specific influence on microcirculatory parameters, since some studies could not show any dependence from gender [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Klos

Gueorguiev

Carow³

et al. 2018

J Orthop Surg Res

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BackgroundDorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon.MethodsIn 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon.ResultsMicroperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p < 0.001), while SO2 was significantly higher at the proximal measurement point (MP 1; p < 0.001). In this area, the lateral approach was significantly superior to the medial approach regarding Flow (MP 1; p = 0.012).The Achilles tendon exhibited a significantly reduced microperfusion 5 cm proximal to the calcaneal tubercle (SO2 p = 0.001; Flow p = 0.048). Demographic factors, such as body mass index and age, had different effects. Microcirculation was partially superior in men and negatively affected by smoking.ConclusionsSoft tissue microcirculation on the lateral and medial side of the healthy Achilles tendon was better than centrally on the tendon. Proximally, the lateral approach was better than the medial approach. These circumstances could provide advantages regarding the surgical approach. The Achilles tendon exhibited significantly reduced microperfusion at the typical side of degeneration and rupture. This circumstance could be a possible cause of degenerative processes.

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“…Regarding limitations of the applied method, it needs to be mentioned that Laser Doppler flowmetry is known to show substantial spatial, temporal, and intra-individual variation [ 13 , 14 ]. Due to the high number of measurement points, depth levels, and time points, it was possible to reduce the impact of this variation by using a LME model for the statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

et al. 2017

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Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.

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Effects of low-intensity pulsed ultrasound on soft tissue micro-circulation in the foot

Abstract: In healthy volunteers, low-intensity pulsed ultrasound led to significant short-term changes in microcirculation of the foot. Younger subjects with a low pre-flow level and smokers showed a higher potential to increase blood flow after LIPUS.

Cited by 23 publications

References 28 publications

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

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