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The International Journal of Lower Extremity Wounds
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A Review of the Microcirculation in Skin in Patients With Chronic Venous Insufficiency: The Problem and the Evidence Available for Therapeutic Options

Uwe Wollina, MD

Department of Dermatology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Germany, wollina-uw{at}khdf.de

Mohamed Badawy Abdel-Naser, MD

Department of Dermatology and Venereology, Ain Shams University Hospital, Cairo, Egypt

Raj Mani, PhD, FACA, D Tech

Vascular Laboratory, Medical Physics and Bioengineering, Southampton University Hospital Trust NHS, Southampton, UK

Impairment of the cutaneous microcirculation is a major predisposing factor in inflammation and ulceration in patients with chronic venous insufficiency (CVI). Increase of capillary filtration rate predisposes to the formation of edema. Local lymphedema is a complication of CVI, often underdiagnosed. This review is focused on CVI but excludes the complication of ulceration. Treatment of microcirculatory dysfunction can be done by pharmacologic intervention or compression therapy or using a combination of both. This review is focused on drugs that have been evaluated by randomized prospective controlled trials. The following compounds are discussed: horse chestnut seed extracts, flavonoids, red vine leaves extracts, total triterpenic fraction of Centella asiatica (L), prociadins, calcium dobesilate, and pentoxifylline. The microcirculatory effects of compression therapy using bandages or stockings are also reviewed. The major microcirculatory effects that have been shown are the reduction of capillary filtration rate and improvements in levels of transcutaneous partial pressures of oxygen and carbon dioxide (TcPO2 and TcPCO2). Available data suggest that a combination of pharmacologic and compression therapy may have some additive effects.

Key Words: skin microcirculation • chronic venous insufficiency • compression therapy • drug therapy

The International Journal of Lower Extremity Wounds, Vol. 5, No. 3, 169-180 (2006)
DOI: 10.1177/1534734606291870
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