Microangiopathy of split-skin grafts in venous ulcers

BACKGROUND. In patients with chronic venous insufficiency, microangiopathy of blood and lymph capillaries caused by venous hypertension plays a major role in the development of venous ulceration. Conservative treatment of venous leg ulcers often fails, and split-skin grafting is sometimes performed. OBJECTIVE. To evaluate the microcirculation and especially the regeneration and function of lymphatic vessels in skin grafts in patients with chronic venous insufficiency. METHODS. The microcirculation of 15 split-skin grafts was studied by fluorescence microlymphography and measurement of transcutaneous oxygen tension (tcpO(2)) in 13 patients. RESULTS. The mean age of the skin grafts was 70.9 months. In only two skin grafts were a few intact lymph meshes found. In all other cases, only fragments of lymphatic capillaries have been detected. In seven skin grafts, cutaneous backflow of dye through insufficient deeper lymph channels was observed. The maximal spread of the dye in the lymphatic network was increased in the skin grafts (17.6+/-22.9 mm). The mean value of tcpO(2) was only 27.1+/-18.1 mm Hg. CONCLUSIONS. In split-skin grafts of patients with venous ulcers, severe microcirculatory changes are present and characterized by hypoxia and abnormal regeneration and function of lymphatic vessels.