Influence of upper limb ischaemia-reperfusion injury on the regulation of cutaneous blood flow during local thermal hyperaemia
McGarr, Gregory Walter
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The present research was developed to investigate the effects of acute upper limb ischaemia- reperfusion (I-R) on neurovascular and endothelial control of the cutaneous micro-circulation in the forearm and finger by evaluating its influence on the magnitude and kinetics of the vasodilatory response to local skin heating. Study 1 investigated between-day reliability of the local heating response in non-glabrous and glabrous index finger skin. Study 2 investigated the effects of I-R on the local heating response in non-glabrous and glabrous skin of the index finger. Study 3 investigated within- and between-day reliability of the local heating response in non-glabrous forearm skin. Study 4 investigated the effects of I-R on the local heating response in non-glabrous forearm skin, as well as the contribution of sensory nerves in mediating the magnitude and kinetics of this response. When data were normalized for blood pressure and expressed as cutaneous vascular conductance (CVC) reliability was generally comparable across all skin sites. In non-glabrous skin reliability was superior when CVC was normalized to maximum heating. At all skin sites, normalizing CVC to baseline produced poor results. Vasodilatory onset time and time to initial peak during local heating produced moderate to good reliability for all skin sites in Studies 1 and 3. In the finger, I-R did not influence the magnitude of the local heating response for the initial peak or plateau phases in either skin type. However, I-R did cause a ~23% delay in vasodilatory onset time and a ~16% delay in time to initial peak in non-glabrous skin. In the forearm, I-R attenuated the initial peak and plateau phases by ~31% and ~34%, respectively. Vasodilatory onset time was also delayed by 34% post-ischaemia. The contribution of sensory nerves in mediating the initial peak and vasodilatory onset time were significantly reduced post-ischaemia, while sensory nerves did not influence the plateau. It is concluded that upper limb I-R impairs the local heating response in non-glabrous forearm and index finger skin. A combination of cutaneous sensory nerve impairment and reduced nitric oxide bioavailability appear to be responsible for attenuating the vasodilatory response to local skin heating under these conditions.