Changes in skin blood flow
To Do, Isobel, Teresa and Lawrence, for their forbearance, and the fine service and ex-service personnel who have suffered for their country.
Sequelae of non-freezing cold injury (NFCI) include sensitivity to further cold exposure, dubbed `cold sensitisation'. This work investigated whether such sensitisation results from sympathetic denervation supersensitivity.
Twenty-two cold-sensitised subjects, with a history of NFCI to the feet, were compared with 10 controls. Skin vascular control was assessed during manoeuvres using laser Doppler. Cold sensitisation resulted in low resting flows, delayed recovery after cold exposure, and attenuation of reactive hyperaemia; expressed relative to resting flow, reactive hyperaemia was proportionately greater. A further study showed that the latter was similar to that in control subjects conditioned to cool environments. Cold-sensitised subjects did not exhibit slowed on or off responses to postural dependency or respiratory manoeuvres. Another experiment confirmed that postural vasoconstriction was greater in magnitude in controls at ambient temperatures of 22° to 26°C, and more variable at 30°C (that used in the main study).
Final experiments examined (veno-arteriolar) responses to dependency and venous occlusion. Topical local anaesthetic and a-adrenergic antagonists attenuated the vasoconstriction, but there was no simple relationship between the magnitude of vasoconstriction and predicted increase in local venous transmural pressure. Responses to dependency in 3 cold-sensitised subjects were indistinguishable from controls, but responses to venous occlusion resembled those of controls treated with local anaesthetic. Vasoconstriction from venous occlusion occurred within 5 seconds of the onset of occlusion, regardless of the distance between occlusion and the site of measurement. More than one pathway appears to be involved in different means of evoking veno-arteriolar responses, with both a1- and a2-adrenergic receptors involved.
Whilst there may be neuro-vascular abnormalities in the cold-sensitised, classical sympathetic denervation supersensitivity is improbable. Other possibilities include chronic endothelial dysfunction following ischaemia-reperfusion, and loss of peripheral perfusion `capacity'.
Non-freezing cold injury is the clinical syndrome which occurs when a periphery, typically foot, sometimes hand, is exposed to cold insufficient to result in the freezing of tissue fluids, but for a sufficient period as to result in local neurological deficit which does not resolve completely within 30 minutes of commencing rewarming.
Cold sensitisation is the clinical syndrome which may occur in a periphery which has previously sustained non-freezing or freezing cold injury, in which local exposure to a cold stress results in a prolonged (and possibly exaggerated) period of local vasoconstriction, which may be associated with pain and neurological disturbance. The symptoms from which someone suffering from cold sensitisation may complain are known as cold sensitivity.
A laser Doppler rheometer is a device which, by shining laser light at the skin, estimates the velocity of red cells within superficial vessels, and their concentration, hence computing a non-dimensional relative estimate of blood flow. These devices are also commonly known as `flowmeters', `fluxmeters', and similar. The term `rheometer' is better formed (being derived from two Greek roots: reos, stream or current, and metron, measure), more euphonious than these more popular alternatives, and is already widely used in other sciences.
Blood flow is the rate of volume movement of blood through a given tissue, whether measured using a technique capable of calibration in absolute terms, or estimated using a laser Doppler rheometer; should there be any uncertainty as to the technique employed, the term will be further qualified to indicate the method of measurement. This therefore includes measures which are termed by some `flux' (which has prior physical usage to express the rate of flow of a fluid across a given area).
A veno-arteriolar response is a reflex-like response in which certain manoeuvres which raise local venular and venous transmural pressures result in an apparent arteriolar vasoconstriction, as demonstrated by a fall in local blood flow.
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