Cutaneous Laser Doppler Flowmetry: Applications and Findings

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Objective

To examine the historical development, evolution, strengths and weaknesses, and applications (current and future) of laser Doppler flowmetry (LDF).

Design

A review and summary of the literature on the cutaneous uses and successful applications of LDF are presented as well as a brief discussion of the noncutaneous and nonvascular applications.

Material and Methods

LDF measures Doppler-shifted quantities of reflected laser light at a superficial level to determine cutaneous and noncutaneous microcirculatory flux of erythrocytes. LDF is noninvasive and inexpensive.

Results

This relatively recent technologic development has shown considerable potential as a tool for evaluating the cutaneous circulation. Although early studies suggested that LDF had substantial difficulties with sampling, stability, and reproducibility, subsequent refinements in equipment and application have led to technical acceptability.

Conclusion

LDF seems to be particularly valuable for assessing the microcirculation and real-time changes in skin blood flow. It has been used successfully in many investigations of the cutaneous and noncutaneous blood flow in patients with fixed or vasospastic vascular disorders, neuropathies, tumors, or ulcers as well as those who have undergone intestinal, orthopedic, or plastic surgical procedures.

Section snippets

NEED FOR NONINVASIVE TESTING OF CBF

A noninvasive, objective means of assessing CBF is important in the evaluation of vasospasm, ischemia, wound and ulcer healing, postoperative survival of grafts, therapeutic trials, and various pathologic conditions. The ideal technique should be reliable and inexpensive as well as provide a direct measurement of CBF. Unfortunately, currently available objective measurements, including arteriography, electromagnetic flow probes, radioactive microsphere deposition, quantitative fluorometry, and

CURRENT METHODS FOR TESTING CBF

The currently available tests for assessing CBF are summarized in Table 1. Each method relies on different physiologic principles; most tests are indirect indices of flow. Of note, LDF is the only technique for direct CBF measurement. Radioisotope washout is specific for CBF but is invasive, indirect, and unamenable to the study of small areas of tissue because of regional averaging. The inability of washout techniques to measure flow in small and discrete regions of skin is a particular

THEORY OF LDF AND CONTROVERSIES

The theory of LDF is that the emitted laser light penetrates tissue to a depth that is dependent on the light frequency. The light is reflected after it strikes either immobile or moving tissues; the portion of this light reflected from moving blood cells undergoes a Doppler shift.17 By sampling all reflected light, the device can calculate flux of erythrocytes within the sample volume.17, 18, 19 Flux is calculated by multiplying the percentage of reflected light returning from moving blood

APPLICATIONS

Throughout the years, a wide variety of clinical applications have been developed for LDF, most for assessing CBF. Disagreements about the technique have resulted from an earlier lack of understanding about the variables that LDF actually detects and how to control for them.

Cutaneous microvascular diseases can be categorized into vasospastic diseases and fixed arterial obstructive diseases.

CONCLUSION

LDF measures Doppler-shifted quantities of reflected laser light at a superficial level to determine cutaneous and noncutaneous microcirculatory flux of erythrocytes, a perhaps useful measure of blood flow and volume. It is noninvasive and inexpensive and has been in clinical use since 1977. Early conclusions about LDF were unfavorable because of comparisons against inadequate standards and a poor understanding of the microvascular physiology. Elements such as rapid and frequent fluctuations in

REFERENCES (87)

  • MD Stern

    In vivo evaluation of microcirculation by coherent light scattering

    Nature

    (1975)
  • MHA Rustin et al.

    The effect of captopril on cutaneous blood flow in patients with primary Raynaud's phenomenon

    Br J Dermatol

    (1987)
  • SA Carter et al.

    Apparent finger systolic pressures during cooling in patients with Raynaud's syndrome

    Circulation

    (1988)
  • HJCM van de Wal et al.

    Noninvasive hemodynamic assessment of vasospasm in patients with primary Raynaud's phenomenon

    Angiology

    (1987)
  • J Ranft

    Stellenwert der Laser-Doppler-untersuchung bei Patienten mit arterieller Verschluβkrankheit. [The status of laser Doppler examination in patients with arterial occlusive disease.]

    Herz

    (1988)
  • ME Lucarotti et al.

    Laser-Doppler velocimetry and photoplethysmography in the diagnosis of abnormal venous reflux

    Phlebologie

    (1988)
  • JP Cooke et al.

    Sex differences in control of cutaneous blood flow

    Circulation

    (1990)
  • M Engelhart et al.

    The blood supply to fingers during Raynaud's attack: a comparison of laser-Doppler flowmetry with other techniques

    Clin Physiol

    (1985)
  • M Nitzan et al.

    Simultaneous measurement of skin blood flow by the transient thermal-clearance method and laser Doppler flowmetry

    Med Biol Eng Comput

    (1988)
  • PR Kvietys et al.

    Laser-Doppler, H2 clearance, and microsphere estimates of mucosal blood flow

    Am J Physiol

    (1985)
  • SJ Burnham et al.

    Objective measurement of limb perfusion by dermal fluorometry: a criterion for healing of below-knee amputation

    Arch Surg

    (1990)
  • LE Ostrander et al.

    A compartment model for fluorometric indication of tissue perfusion

    IEEE Trans Biomed Eng

    (1990)
  • H Boccalon et al.

    Phénomène de Raynaud, Doppler au laser, caisson isotherme. Exploration de sujets normaux et pathologiques. [Raynaud's phenomenon, laser Doppler, isothermal chamber: exploration of normal and pathologic subjects.]

    J Mal Vasc

    (1985)
  • E Arosio et al.

    Efficacy of ketanserin in the therapy of Raynaud's phenomenon: thermometric data

    Angiology

    (1991)
  • O Bongard et al.

    Effects of oxygen inhalation on skin microcirculation in patients with peripheral arterial occlusive disease

    Circulation

    (1992)
  • AL Nilsson et al.

    Effects of local convective cooling and rewarming on skin blood flow

    Int J Microcirc Clin Exp

    (1986)
  • DJ Haumschild

    Microvascular blood flow measurement by laser Doppler flowmetry [TSI application note]. St

    (1986)
  • DJ Haumschild

    An overview of laser Doppler flowmetry

    Biomed Sci Instrum

    (1986)
  • T Tanaka et al.

    Measurement of the velocity of blood flow (in vivo) using a fiber optic catheter and optical mixing spectroscopy

    Appl Opt

    (1975)
  • R Bonner et al.

    Model for laser Doppler measurements of blood flow in tissue

    Appl Opt

    (1981)
  • K Hirata et al.

    Partitional measurement of capillary and arteriovenous anastomotic blood flow in the human finger by laser-Doppler-flowmeter

    Eur J Appl Physiol

    (1988)
  • AN Obeid et al.

    A critical review of laser Doppler flowmetry

    J Med Eng Technol

    (1990)
  • A Scheffler et al.

    A microcomputer system for evaluation of laser Doppler blood flux measurements

    Int J Microcirc Clin Exp

    (1990)
  • SD Jenkins et al.

    Routine clinical use of laser Doppler flowmeter to monitor free tissue transfer: preliminary results

    J Reconstr Microsurg

    (1987)
  • G Belcaro et al.

    Microvascular evaluation of the effects of nifedipine in vascular patients by laser-Doppler flowmetry

    Angiology

    (1989)
  • A Creutzig et al.

    Temperature-dependent laser Doppler fluxmetry in healthy and patients with peripheral arterial occlusive disease

    Int J Microcirc Clin Exp

    (1987)
  • T Winsor et al.

    Clinical application of laser Doppler flowmetry for measurement of cutaneous circulation in health and disease

    Angiology

    (1987)
  • L Caspary et al.

    Comparison of laser-Doppler-flux and tcPO2 in healthy probands and patients with arterial ischemia

    Adv Exp Med Biol

    (1987)
  • G Belcaro et al.

    Skin flow and swelling in post-phlebitic limbs

    Vasa

    (1989)
  • J Ninet et al.

    Laser Doppler flux monitored cutaneous response to local cooling and heating

    Vasa

    (1985)
  • M Rendell et al.

    Microvascular blood flow, volume, and velocity measured by laser Doppler techniques in IDDM

    Diabetes

    (1989)
  • G Belcaro et al.
  • K Kvernebo et al.

    Laser Doppler flowmetry in evaluation of lower limb resting skin circulation: a study in healthy controls and atherosclerotic patients

    Scand J Clin Lab Invest

    (1988)
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