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The Influence of Sympathetic Nerves on Transcutaneous Oxygen Tension in Normal and Ischemic Lower Extremities

Mayo Clinic and Mayo Foundation, Division of Cardiovascular Diseases

Larry H. Hollier

Head, Section of Vascular Surgery, Rochester, Minnesota

Philip J. Osmundson

Mayo Clinic and Mayo Foundation, Division of Cardiovascular Diseases

The authors evaluated the relationship between sympathetic nerve activity and transcutaneous oxygen tension (TcpO₂) in normal and ischemic lower extremities. Dorsal foot TcpO₂ was measured by using oxygen-sensing electrodes with surface temperatures of 42 ° C and 45°C; in theory, changes in sympathetic activity should affect vasomotor tone and TcpO₂ in skin beneath an electrode at 42 °C (submaximal vasodilation), but not at 45°C (maximal vasodilation). The vasodilation index (TcpO₂ at 42°C/TcpO ₂ at 45°C) was created as an index of vasomotor tone (vasodilation index increases as tone decreases). In normal limbs (n=24) averages for TcpO ₂ at 42°C, TcpO₂ at 45°C, and vasodilation index were 30.3 mmHg, 62.1 mmHg, and 0.47, respectively. In subjects (n=5) with quadriplegia and reduced sympathetic tone secondary to cervical cord trauma, TcpO ₂ at 42 ° C and vasodilation index were increased (45.0 mmHg and 0.61); TcpO₂ at 45 ° C did not change. When normal subjects (n=7) were chilled for twenty minutes with a cooling blanket at 5 ° C (to increase sympathetic tone) average vasodilation index dropped from 0.50 to 0.29. Among ischemic limbs (n = 34) vasodilation index was highly variable (range: 0-0.77); in general, vasodilation index fell as the ischemia worsened. In a subset of patients with ischemic limbs, the vasodilation index increased after the limb was wrapped in a warm dressing (average vasodilation index=0.25without dressing, 0.37 with dressing). The authors conclude: (1) TcpO₂ can be used to assess the degree of vasomotor tone (and sympathetic activity) in skin; (2) tone generally increases as ischemia worsens; and (3) local warmth can improve cutaneous circulation in ischemic limbs.

Angiology, Vol. 38, No. 5, 400-410 (1987)
DOI: 10.1177/000331978703800508


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