Methods of skin microcirculation assessment

Authors: J. Tomešová 1;  J. Gruberová 1;  P. Brož 2;  S. Lacigová 1;  M. Krčma 1;  Z. Rušavý 1
Authors‘ workplace: Diabetologické centrum I. interní kliniky Lékařské fakulty UK a FN Plzeň, přednosta prof. MU Dr. Martin Matějovič, Ph. D. 2 Ústav klinické bio­chemie a hematologie Lékařské fakulty UK a FN Plzeň, přednosta prof. MU Dr. Jaroslav Racek, DrSc. 1
Published in: Vnitř Lék 2013; 59(10): 895-902
Category: Review


Microcirculation plays an important role in pathophysiology of a number of severe diseases. At present there exist many techniques that enable evaluation of microvascular perfusion. Some of them found their scientific and clinical use even in the Czech Republic. In last decade, articles referring about individual methods can be found even on the pages of Vnitřní lékařství journal. The aim of this work is to provide a comprehensive overview of methods that have been used for examination of the microcirculation to date. After a short review of the anatomy and physiology of the microcirculation, the article provides synopsis of the theoretical and practical use of individual methods including their advantages and disadvantages.

Key words:
microcirculation –  microvascular perfusion –  Laser Doppler technique –  transcutal oxymetry –  capillaroscopy


1. Freccero C, Holmlund F, Bornmyr S et al. Laser Doppler perfusion monitoring of skin blood flow at different depths in finger and arm upon local heating. Microvasc Res 2003; 66: 183– 189.

2. Flynn MD, Tooke JE. Microcirculation and the diabetic foot. Vasc Med Rev 1990; 1: 121– 138.

3. Hamdy O, Abou‑ Elenin K, LoGerfo FW et al. Contribution of nerve‑ axon reflex‑related vasodilation to the total skin vasodilation in diabetic patients with and without neuropathy. Diabetes Care 2001; 24: 344– 349.

4. Chao CY, Cheing GL. Microvascular dysfunction in diabetic foot disease and ulceration. Diabetes Metab Res Rev 2009; 25: 604– 614.

5. Caselli A, Rich J, Hanane T et al. Role of C‑ nociceptive fibers in the nerve axon reflex‑related vasodilation in diabetes. Neurology 2003; 60: 297– 300.

6. Iwase M, Imoto H, Murata A et al. Altered postural regulation of foot skin oxygenation and blood flow in patients with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 2007; 115: 444– 447.

7. Verma S, Buchanan MR, Anderson TJ. Endothelial function testing as a bio­marker of vascular disease. Circulation 2003; 108: 2054– 2059.

8. Funk SD, Yurdagul A Jr, Orr AW. Hyperglycemia and endothelial dysfunction in atherosclerosis: lessons from type 1 diabetes. Int J Vasc Med 2012; 2012: 569654.

9. Roustit M, Cracowski JL. Non‑ invasive assessment of skin microvascular function in humans: an insight into methods. Microcirculation 2012; 19: 47– 64.

10. Holowatz LA, Thompson‑ Torgerson CS, Kenney WL. The human cutaneous circulation as a model of generalized microvascular function. J Appl Physiol 2008; 105: 370– 342.

11. Levy BI, Schiffrin EL, Mourad JJ et al. Impaired tissue perfusion: a pathology common to hypertension, obesity, and diabetes mellitus. Circulation 2008; 118: 968– 976.

12. Yamamoto‑ Suganuma R, Aso Y. Relationship between post‑occlusive forearm skin reactive hyperaemia and vascular disease in patients with Type 2 diabetes –  a novel index for detecting micro‑ and macrovascular dysfunction using laser Doppler flowmetry. Diabet Med 2009; 26: 83– 88.

13. Kruger A, Stewart J, Sahityani R et al. Laser Doppler flowmetry detection of endothelial dysfunction in end‑stage renal disease patients: cor­relation with cardiovascular risk. Kidney Int 2006; 70: 157– 164.

14. Engelberger RP, Pittet YK, Henry H et al. Acute endotoxemia inhibits microvascular nitric oxide‑ dependent vasodilation in humans. Shock 2011; 35: 28– 34.

15. Roustit M, Blaise S, Millet C et al. Reproducibility and methodological issues of skin post‑occlusive and thermal hyperemia assessed by single‑point laser Doppler flowmetry. Microvasc Res 2010; 79: 102– 108.

16. Ramsay JE, Ferrell WR, Greer IA et al. Factors critical to iontophoretic assessment of vascular reactivity: implications for clinical studies of endothelial dysfunction. J Cardiovasc Pharmacol 2002; 39: 9– 17.

17. Turner J, Belch JJ, Khan F. Current concepts in assessment of microvascular endothelial function using laser Doppler imaging and iontophoresis. Trends Cardiovasc Med 2008; 18: 109– 116.

18. Urbanová R, Jirkovská A, Wosková V et al. Transcutaneous oximetry in the dia­gnosis of ischemic disease of the lower extremities in diabetics. Vnitř Lék 2001; 47: 330– 332.

19. Schaper NC. Specific Guidelines for the dia­gnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev 2012; 28 (Suppl 1): 236– 237.

20. Cechurová D, Rusavý Z, Lacigová S et al. Transcutaneous oxygen tension in hyperbaric condition as a predictor of ischaemia in non‑healing diabetic foot ulcers. Vnitř Lék 2002; 48: 971– 975.

21. Standards of medical care in diabetes –  2012 (position statement). Diabetes Care 2012; 35 (Suppl 1): 11– 63.

22. Kawadara O. Assessment of macro‑ and microcirculation in contemporary critical limb ischemie. Catheter Cardiovasc Interv 2011; 78: 1051– 1058.

23. Takáts A, Garai I, Papp G et al. Raynaud’s syndrome, 2011. Orv Hetil 2012; 153: 403– 409.

24. Li LG, Zhang JL, Liu XH et al. The dia­gnostic significance of naifold video‑ capillaroscopy in systemic sclerosis. Zhonghua Nei Ke Za Zhi 2012; 51: 362– 365.

25. Bezemer R, Dobbe JG, Bartels SA et al. Rapid automatic assessment of microvascular density in sidestream dark field images. Med Biol Eng Comput 2011; 49: 1269– 1278.

26. Lindert J, Werner J, Redlin M et al. OPS imaging of human microcirculation: a short technical report. J Vasc Res 2002; 39: 368– 372.

27. Treu CM, Lupi O, Bottino DA et al. Sidestream dark field imaging: the evolution of real‑ time visualization of cutaneous microcirculation and its potential application in dermatology. Arch Dermatol Res 2011; 303: 69– 78.

28. De Backer D, Creteur J, Dubois MJ et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 2006; 34: 403– 408.

29. Sakr Y, Dubois MJ, De Backer D et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 2004; 32: 1825– 1831.

30. Pérez‑ Bárcena J, Goedhart P, Ibáñez J et al. Direct observation of human microcirculation during decompressive craniectomy after stroke. Crit Care Med 2011; 39: 1126– 1129.

31. Schmitz V, Schaser KD, Olschewski P et al. In vivo visualization of early microcirculatory changes following ischemia/ reperfusion injury in human kidney transplantation. Eur Surg Res 2008; 40: 19– 25.

32. Puhl G, Schaser KD, Vollmar B et al. Non­invasive in vivo analysis of the human hepatic microcirculation using orthogonal polorization spectral imaging. Transplantation 2003; 75: 756– 761.

33. Kaiser M, Yafi A, Cinat M et al. Noninvasive assessment of burn wound severity using optical technology: a review of current and future modalities. Burns 2011; 37: 377– 386.

34. Virgini‑Magalhães CE, Porto CL, Fernandes FF et al. Use of microcirculatory parameters to evaluate chronic venous insufficiency. J Vasc Surg 2006; 43: 1037– 1044.

35. Beed M, O’Connor MB, Kaur J et al. Transient hyperaemic response to assess skin vascular reactivity: effects of heat and iontophoresed norepinephrine. Br J Anaesth 2009; 102: 205– 209.

36. Victor RG, Leimbach WN Jr, Seals DR et al. Effects of the cold pressor test on muscle sympathetic nerve activity in humans. Hypertension 1987; 9: 429– 436.

37. Roustit M, Maggi F, Isnard S et al. Reproducibility of a local cooling test to assess microvascular function in human skin. Microvasc Res 2010; 79: 34– 39.

38. Minson CT. Thermal provocation to evaluate microvascular reactivity in human skin. J Appl Physiol 2010; 109: 1239– 1246.

39. Tee GB, Rasool AH, Halim AS et al. Dependence of human forearm skin postocclusive reactive hyperemia on occlusion time. J Pharmacol Toxicol Methods 2004; 50: 73– 78.

40. Johnson JM, Kellogg DL Jr. Local thermal control of the human cutaneous circulation. J Appl Physiol 2010; 109: 1229– 1238.

41. Rajan V, Varghese B, van Leeuwen TG et al. Review of methodological developments in laser Doppler flowmetry. Lasers Mes Sci 2009; 24: 269– 283.

42. Tesselaar E, Sjöberg F. Transdermal iontophoresis as an in‑vivo technique for studying microvascular physiology. Microvasc Res 2011; 81: 88– 96.

43. Murray AK, Moore TL, King TA et al. Vasodilator iontophoresis a possible new therapy for digital ischaemia in systemic sclerosis? Rheumatology (Oxford) 2008; 47: 76– 79.

44. Sárník S, Hofírek I, Panovský R. Monitoring functional disorders of microcirculation using laser doppler flowmetry in patients with chronic venous insufficiency class 2 according to CEAP classification before and after varicose veins surgery. Vnitř Lék 2007; 53: 1286– 1295.

45. Ubbink DT, Jacobs MJ, Tangelder GJ et al. The usefulness of capillary microscopy, transcutaneous oximetry and laser Doppler fluxmetry in the assessment of the severity of lower limb ischae­mia. Int J Microcirc Clin Exp 1994; 14: 34– 44.

46. Krsek M, Prázný M, Sucharda P et al. Changes in serum levels of IGF‑I and its binding proteins and their relation to microcirculation in obese patients. Vnitř Lék 2001; 47: 847– 851.

47. Luckner G, Dünser MW, Stadlbauer KH et al. Cutaneous vascular reactivity and flow motion response to vasopressin in advanced vasodilatory shock and severe postoperative multiple organ dysfunction syndrome. Crit Care 2006; 10: R40.

48. Hofírek I, Sochor O, Olsovský J. Assessment of changes in peripheral microcirculation in type I diabetics with laser doppler flowmetry. Vnitř Lék 2004; 50: 836– 841.

49. Jorneskog G. Why critical limb ischemia criteria are not applicable to diabetic foot and what the consequences are. Scand J Surg 2012; 101: 114– 118.

50. Mahé G, Humeau‑ Heurtier A, Durand S et al. Assessment of skin microvascular function and dysfunction with laser speckle contrast imaging. Circ Cardiovasc Imaging 2012; 5: 155– 163.

51. O‘Doherty J, McNamara P, Clancy NT et al. Comparison of instruments for investigation of microcirculatory blood flow and red blood cell concentration. J Biomed Opt 2009; 14: 034025.

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