Deng Aidong, Liu Dan, Gu Chen, Gu Xiaosong, Gu Jianhui, Hu Wen
Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, PR China.
Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China.
Brain Res. 2016 Jan 1;1630:38-49. doi: 10.1016/j.brainres.2015.10.045. Epub 2015 Oct 31.
Cutaneous vasoconstriction/vasodilatation occurs in response to whole body and local cooling/heating, and the vasomotor activities play a pivotal role in thermal control of the human body. The mechanisms underlying regulation of skin blood flow involve both neurogenic and humeral/local chemical influence, contributing to the initial response to thermal stimuli and the prolonged phase of response, respectively. Previous studies have suggested the impairment of cutaneous thermal regulation after nerve injury. However, the evidence regarding how the skin perfusion and thermoregulatory response evolve after nerve injury and repair remains limited. Here we observed, by utilizing laser-Doppler perfusion imaging, baseline skin perfusion and perfusion change in response to thermal stimuli after median and ulnar nerve injury, and the results showed that baseline perfusion in autonomous skin area profoundly decreased and active rewarming after clod stress dramatically diminished before sensory recovery of the skin became detectable. In addition, baseline cutaneous perfusion was recovered as the skin regained touch sensation, and exhibited positive correlation to touch sensibility of the skin. These data indicate that both active perfusion and thermoregulatory response of the skin are markedly compromised during skin denervation and can be recovered by re-innervation. This suggests the importance of timely repair of injured nerve, especially in the practice of replantation.
皮肤血管收缩/舒张是对全身及局部冷却/加热的反应，血管运动活动在人体体温调节中起关键作用。皮肤血流调节的机制涉及神经源性和体液/局部化学影响，分别促成对热刺激的初始反应和反应的延长阶段。先前的研究提示神经损伤后皮肤体温调节受损。然而，关于神经损伤和修复后皮肤灌注及体温调节反应如何演变的证据仍然有限。在此，我们通过激光多普勒灌注成像观察了正中神经和尺神经损伤后自主皮肤区域的基线皮肤灌注及对热刺激的灌注变化，结果显示在皮肤感觉恢复可检测到之前，自主皮肤区域的基线灌注显著降低，冷应激后的主动复温显著减弱。此外，随着皮肤恢复触觉，基线皮肤灌注得以恢复，且与皮肤触觉敏感性呈正相关。这些数据表明，皮肤去神经支配期间皮肤的主动灌注和体温调节反应均显著受损，且可通过重新神经支配得以恢复。这提示及时修复受损神经的重要性，尤其是在再植手术中。
