Abstract
Forty-one biopsy specimens, taken from the ulcer-bearing skin of 41 legs of 21 patients attending the varicose vein clinic, were selectively stained for fibrin with phosphotungstic acid haemotoxylin before being blindly assessed,. Layers of fibrin were found surrounding the dermal capillaries in all 26 legs with lipodermatosclerosis. None of the specimens from the 15 legs with clinically normal skin contained fibrin. There was also an increased number of dermal capillaries cut in cross section per high powered field in 24 of the 26 legs with lipodermatosclerosis compared with two of the 15 legs with normal skin (p less than 0.001). The mean reduction in foot vein pressure during exercise was significantly less in the 26 limbs with pericapillary fibrin than in the other 15 limbs (p less than 10(-6). Lipodermatosclerosis is synonymous with pericapillary fibrin deposition and is associated with, and probably secondary to, both a persistently raised venous pressure and an increase in the size of the dermal capillary bed. This extravascular deposition of fibrin probably stimulates tissue fibrosis and blocks the diffusion of oxygen to the overlying epidermis, producing cellular death and venous ulceration.
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Selected References
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- Browse N. L., Jarrett P. E., Morland M., Burnand K. Treatment of liposclerosis of the leg by fibrinolytic enhancement: a preliminary report. Br Med J. 1977 Aug 13;2(6084):434–435. doi: 10.1136/bmj.2.6084.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burnand K. G., O'Donnell T. F., Jr, Thomas M. L., Browse N. L. The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery. 1977 Jul;82(1):9–14. [PubMed] [Google Scholar]
- Burnand K. G., Whimster I., Clemenson G., Thomas M. L., Browse N. L. The relationship between the number of capillaries in the skin of the venous ulcer-bearing area of the lower leg and the fall in foot vein pressure during exercise. Br J Surg. 1981 May;68(5):297–300. doi: 10.1002/bjs.1800680502. [DOI] [PubMed] [Google Scholar]
- Burnand K., Clemenson G., Morland M., Jarrett P. E., Browse N. L. Venous lipodermatosclerosis: treatment by fibrinolytic enhancement and elastic compression. Br Med J. 1980 Jan 5;280(6206):7–11. doi: 10.1136/bmj.280.6206.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Holling H. E., Beecher H. K., Linton R. R. STUDY OF THE TENDENCY TO EDEMA FORMATION ASSOCIATED WITH INCOMPETENCE OF THE VALVES OF THE COMMUNICATING VEINS OF THE LEG. OXYGEN TENSION OF THE BLOOD CONTAINED IN VARICOSE VEINS. J Clin Invest. 1938 Sep;17(5):555–561. doi: 10.1172/JCI100980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- PIULACHS P., VIDAL-BARRAQUER F. Pathogenic study of varicose veins. Angiology. 1953 Feb;4(1):59–99. doi: 10.1177/000331975300400108. [DOI] [PubMed] [Google Scholar]
- Pietra G. G., Szidon J. P., Leventhal M. M., Fishman A. P. Hemoglobin as a tracer in hemodynamic pulmonary edema. Science. 1969 Dec 26;166(3913):1643–1646. doi: 10.1126/science.166.3913.1643. [DOI] [PubMed] [Google Scholar]
- Rhodin J. A. Ultrastructure of mammalian venous capillaries, venules, and small collecting veins. J Ultrastruct Res. 1968 Dec;25(5):452–500. doi: 10.1016/s0022-5320(68)80098-x. [DOI] [PubMed] [Google Scholar]
- SHIRLEY H. H., Jr, WOLFRAM C. G., WASSERMAN K., MAYERSON H. S. Capillary permeability to macromolecules: stretched pore phenomenon. Am J Physiol. 1957 Aug;190(2):189–193. doi: 10.1152/ajplegacy.1957.190.2.189. [DOI] [PubMed] [Google Scholar]
- Thomas M. L. Phlebography. Arch Surg. 1972 Feb;104(2):145–151. doi: 10.1001/archsurg.1972.04180020025005. [DOI] [PubMed] [Google Scholar]