A simplified evaluation of vital capillary microscopy for predicting skin viability in patients with severe arterial insufficiency.

In the present study the predictive value of a simplified VCM (Vital Capillary Microscopy) classification in assessing the development of skin necrosis was investigated in 69 patients with severe peripheral arterial obliterative disease (AOD) of the leg. The arterial circulation of the foot was evaluated by systolic blood pressure (SBPt). The structure and blood filling of the skin capillaries of all toes and forefeet were evaluated by an ordinary stereo-microscope at a magnification of 10 to 40 times. A three stage classification was used for evaluating the nutritive skin capillaries: Stage A, B and C. The individual patient was classified according to the worst stage found in the foot. The predictive value for the SBPt measurements with regard to the development of skin necrosis was for the best group (21-30 mmHg) 6%, for the middle group (11-20 mmHg) 58% and for the worst group (0-10 mmHg) 56%. The predictive values for the VCM Stages A, B and C were 5, 16 and 93% respectively. The sensitivity with the borderline between Stage A and B + C was 97% and the specificity 53%. With the borderline between stage A + B and C the sensitivity and specificity became 87% and 95% respectively. It may be concluded that the VCM classification with three stages used in the present study seems to be very useful for predicting the risk of skin necrosis in patients with severe AOD.