McGill D J, Mackay I R
Laser Suite, Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
Br J Dermatol. 2006 May;154(5):896-903. doi: 10.1111/j.1365-2133.2005.07124.x.
Following pulsed dye laser (PDL) treatment of capillary vascular malformations (CMs), the capillaries left behind tend to be smaller and deeper. The PDL is most effective against capillaries over 50 microm, suggesting that clearance of CM could be improved by inducing capillary vasodilation of the smaller remaining capillaries. However, there are reduced perivascular nerves within CMs, implying that autonomic innervation to these capillaries may be abnormal.
To investigate whether CM capillaries will vasodilate in response to autonomic stimulation by raising ambient temperature.
Ten patients with untreated CMs and nine with previously laser-treated CMs were studied as ambient temperature was increased from 20 degrees C to 28 degrees C. The following measurements were taken at 2 degrees C intervals: skin blood flow (SBF); capillary diameter and depth; CM colour; and skin and core temperatures.
All the subjects studied demonstrated superficial capillary vasodilation and increased SBF as the ambient temperature was raised from 20 degrees C to 28 degrees C. Mean+/-SEM capillary diameter increased from 66+/-7 microm to 110+/-13 microm (P<0.001) in the untreated group, compared with an increase from 28+/-5 microm to 70+/-14 microm (P<0.001) in the treated group. Mean+/-SEM SBF increased from 427.2+/-98.2 perfusion units (PU) to 580.9+/-92.7 PU (P<0.01) in the untreated group, compared with an increase from 201.3+/-28.4 PU to 458.1+/-53.7 PU (P<0.05) in the treated group.
Superficial capillary vasodilation within CM is achievable by raising ambient temperature, including in those patients resistant to PDL treatment, potentially allowing further clearance of these lesions.
在脉冲染料激光（PDL）治疗毛细血管畸形（CMs）后，残留的毛细血管往往更小且更深。PDL对直径超过50微米的毛细血管最有效，这表明通过诱导剩余较小毛细血管的血管舒张，可以改善CM的清除效果。然而，CM内的血管周围神经减少，这意味着这些毛细血管的自主神经支配可能异常。
通过提高环境温度来研究CM毛细血管是否会对自主神经刺激产生血管舒张反应。
对10例未经治疗的CM患者和9例先前接受过激光治疗的CM患者进行研究，环境温度从20℃升高到28℃。每隔2℃进行以下测量：皮肤血流量（SBF）、毛细血管直径和深度、CM颜色以及皮肤和核心温度。
随着环境温度从20℃升高到28℃，所有研究对象均表现出浅表毛细血管舒张和SBF增加。未治疗组的平均±标准误毛细血管直径从66±7微米增加到110±13微米（P<0.001），而治疗组从28±5微米增加到70±14微米（P<0.001）。未治疗组的平均±标准误SBF从427.2±98.2灌注单位（PU）增加到580.9±92.7 PU（P<0.01），而治疗组从201.3±28.4 PU增加到458.1±53.7 PU（P<0.05）。
通过提高环境温度可实现CM内浅表毛细血管舒张，包括对PDL治疗耐药的患者，这可能有助于进一步清除这些病变。
