Skin Perfusion Pressure (SPP) Assessments with
Contents
1. Sequence 1 valueBZ 4 94 4 eee a ae Talk Pres Ch Pres 175 170 165 160 155 150 145 140 135 130 125 120 115 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 Meas Ch Flux1 EE EES Pressure mmH Pres 180 mmHg SPP 63 5 mmHg pusit Deflat 4 mmHg s Select Sequence No S Auto Pressure 6 fo amp Add to Reporti AlChanels Tmejpres Axis SAVE DATA EXPORT REPORT PREVIEW SPP results chart enhances the speed of obtaining required data In the example shown above the following protocol was used Inflate pressure automatically to 180 mmHg and hold for 19 seconds controlled deflation at rate of 5 mmHg s Flux was constantly monitored and is also shown on the chart Yellow and blue lines indicate inflation holding deflation and abort markers The site target pressure and deflation rate are displayed in the bottom right info box SPP is calculated when the Flux returns to 1 5 x biological zero which is shown by the SPP marker in the above figure indicated by the vertical red line A different SPP detection point can be selected from the Report Design You can also measure SPP manually by moving the red line Practical Suggestions Microvascular blood flow can be affected by many things The following practical suggestions are provided as a guide and are not exhaustive e Perform measurements in a quiet room whilst maintaining a comfortable temperature typically 22 C Ensure the patient is ac2. Surgery 32 1 pp 32 36 Tsuji Y Hiroto T Kitano l Tahara S Sugiyama D 2008 Importance of skin perfusion pressure in treatment of critical limb ischemia Wound Research Apr 2008 Issue 4 Utsunomiya M Nakamura M Nagashima Y Sugi K 2013 Predictive value of skin perfusion pressure after endovascular therapy for wound heal of critical limb ischemia Journal of the American College of Cardiology Volume 61 Issue 10 Supplement 12 March 2013 pp E1805 Yamada T Ohta T Ishibashi H Sugimoto l Iwata H Takahashi M Kawanishs J 2008 Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs Comparison with other non invasive diagnostic methods Journal of Vascular Surgery 47 2 pp 318 323 Further Reading www moor co uk information about moorVMS VASC and available probes and pressure cuffs moorVMS LDF user manual for instrument operation and cleaning and handling of optical probes Please feel free to consult sales moor co uk for further advice or Support with issues not covered in this application note and for details of other application notes using the moorVMS VASC system Important Disclaimer This information is provided to further clinical research into diagnostic capabilities of laser Doppler The moorVMS VASC is CE marked for human use but not specifically for clinical diagnosis of SPP assessments Calibrated equipment with a current service record should only
3. be used Notes W moor instruments innovation in microvascular assessment Moor Instruments Ltd Millwey Axminster Devon EX13 5HU UK tel 44 0 1297 35715 fax 44 0 1297 35716 email sales moor co uk website www moor co uk Issue 2
4. m Select Protocol Skin Perfusion Pressure Skin Perfusion Pressure Duration sec Pressure Rate m Pre inflation 0 Ea Inflation Skin Perfusion Pressure Hold Time 10 Deflation Limb Toe Blood Pressure 5 Postdeflation 0 Pulse Volume PORH User Defined Protocol ABPI TBPI Limits 0 600sec 20 250mmHg 1 10mmHgq s or Max moorVMS VASC Simple protocol Set up Skin Perfusion Pressure Demographics History r Patient Details r Test Details Given Name Family Name EE ee Bill ag Operator Dr Holliday Test Sequence Ankle Brachial Pressure Index Date Of Bith 26112013 ere Hospital No oo Comments Gender Male C Female Height 150 cm Weight 75 Kg Visit Status lntia gl Primary Diagnosis None X m Data Location Database C Dat Concomitant Disease None z E a Data Folder C Data mo File Name r Database Nayigation a Open Record Clinically user friendly software aims to helo standardise test procedures protocols at your institution Analysis The SPP report contains the SPP charts in addition to the following statistical information e Site e Flux ch e SPP mm Hg e Pressure ch e Flux PU e Average e Flux BZ e Press calc e Time hh mm ss e Mean SPP mm Hg e Deflation mm Ho s Sian Perfusion Pressure AA 1 second Averaged ied N N
5. climatised to the room temperature for 30 minutes prior to measurements e Patients should avoid caffeine high salt food alcohol vigorous exercise and smoking for 24 hours prior to the study e During measurements ask the patient to breathe normally Coughing talking and yawning can all affect microvascular blood flow readings e The patient should be in a comfortable relaxed position and avoid movement during all measurements Related Fields Contact us for Application Notes for Post Occlusion Reactive Hyperaemia PORH Toe Pressure TP Pulse Volume PV and Ankle Brachial Pressure Index ABPI measurements with the moorVMS VASC Publications Castronuovo J J 1997 Diagnosis of critical limb ischemia with skin perfusion pressure measurements The Journal of Vascular Technology 21 3 pp 175 179 Castronuovo J J Adera H M Smiell J M Price R 1997 Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischemia Journal of Vascular Surgery 26 4 pp 629 637 Jan YK Liao F Jones M A Rice L A Tisdell T 2013 Effect of Durations of Wheelchair Tilt in Space and Recline on Skin Perfusion Over the Ischial Tuberosity in People with Spinal Cord Injury Archives of Physical Medicine and Rehabilitation 94 4 pp 667 672 Castronuovo J J Carter S A 2000 Skin perfusion pressure of the foot is a good substitute for toe pressure in the assessment of limb ischemia Journal of Vascular
6. f SPP The user friendly PC software enables test procedures to be written which exactly match your requirements enabling standardisation of test procedures in your institution With the moorVMS VASC you can be sure test procedures are easily repeatable across your institution Equioment Required The following equipment is needed for this application ro 7 ee ay moor instruments laser Copper Vascular Assessment Main Menu NEW m Saee moorVMS VASC moorVMS VASC PC software VP11sc low cart optional orofile optic probe eg K Y or ultrasound Easy Care Cuff Inflatable pressure cuff The cuff used will depend upon patient and limb size e g arm thigh lower leg etc Method e Refer to the Practical Suggestions section of this Application Note for environmental and patient recommendations e Ensure skin probes are calibrated See moorVMS LDF user manual e Measurements should be made with the patient in the supine position with the limb to be measured at heart level e Apply a small amount of gel to the optic aperture on the VP11sc to improve optical coupling e Place a pressure cuff around the limb with the skin probes in the measurement position under the pressure cuff e Select your pre defined test using the moorVMS VASC PC software adjust for preferred protocol see moorVMS VASC user manual General Options Report Options Pressure Reports Test Sequence Setup Test Defaults
7. innovation in microvascular assessment W moor instruments Skin Perfusion Pressure SPP Assessments with the moorVMS VASC Application note 105 Application Skin Perfusion Pressure SPP is the pressure required for restoring microcirculatory blood flow following release of carefully controlled occlusion The measurement of SPP with laser Doppler is a non invasive test It has proved useful in the assessment of peripheral arterial disease PAD for both critical ischemia Utsunomiya 2013 Castronuovo 1997 Castronuovo et al 1997 and also for the determination of optimal levels for amputation Tsuji et al 2008 There are also indications in the literature that SPP measurements are useful indicators for wound healing potential Yamada et al 2008 and more recently for the investigation of ischemia over the ischial tuberosity in people with spinal cord injury Jan et al 2013 SPP provides a good indication of the status of the proximal arterial system whilst remaining unaffected by conditions such as arterial wall calcification commonly seen in diabetic patients with PAD for example Foot SPP has also been shown to correlate well to toe pressure and would be useful in situations where toe pressure measurements are not possible due to toe amputation ulceration or gangrene Tsai et al 2000 Test Standardisation The moorVMS VASC is a dedicated vascular monitoring system which enables simple rapid and reproducible measurement o
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