Hand Cutaneous Perfusion Dynamics in Plastic Surgery: A Feasibility Study of Hand Cutaneous Microcirculation During Standard Practices in Plastic Surgery Using Laser Doppler Flowmetry

Introduction

Upper limb injuries are common, accounting for a significant proportion of unplanned visits to hospital services in the UK. The severity of such injuries varies significantly. In its most severe form, substantial injuries require immediate specialist input and subsequent long-term rehabilitation. Poor management can result in loss of function and disability, leading to loss of productivities and independence.

Elevation of the limb is a routine practice following an injury to the limbs, as it is thought to be able to reduce oedema secondary to inflammation and venous pooling through gravity. However, it has been suggested that elevation may reduce local blood flow in selected situations due to increased hydrostatic pressure created by limb elevation. There appears to be no census to the ideal duration and position of limb elevation. The evidence of ideal duration and position of elevation remains sparse.

Laser Doppler Flowmetry (LDF) is a non-invasive, probe-based perfusion monitoring technique which has been used in many clinical and research settings unrelated to hand surgery. This feasibility study aims to determine whether LDF can be used for research of hand cutaneous perfusion dynamics in common hand surgery practices such as limb elevation.

Methods

The PeriFlux 5000 LDF system was used to investigate how cutaneous perfusion alters according to the different hand locations in healthy participants. From this initial hand mapping experiment, an optimal point of measurement was found. This point was used for the subsequent elevation experiment where the cutaneous perfusion level was measured as the participants place their arm and forearm into five different positions of varying degrees of elevation.

Results

Laterality and hand dominance status does not influence the level of cutaneous circulation on the hand. There are significant differences in the level of circulation between the volar and dorsal aspect of the hand, as well as between digital and hand measurements. Cutaneous perfusion levels do not alter significantly between different digits provided the same locations are measured. Elevation of the limb leads to a reduction of cutaneous perfusion in a degree dependent manner.

Discussion

This study appears to be the first mapping study of cutaneous perfusion of the hand with LDF to date. Further insight into upper limb perfusion dynamics is gained from the elevation study. This feasibility study has found that LDF is well tolerated by participants and provides objective measurements of cutaneous perfusion. Further research would be helpful to further our understanding and further optimise outcomes in patients with upper limb conditions.