ABSTRACT
We have encountered situations of patients with critical limb ischemia accompanied
by pain at rest and necrosis, who hang their legs down from the bed during sleep.
This lower limb position is known to be a natural position, which reduces pain in
the lower extremity induced by ischemia. However, the effect of this position on blood
flow of the lower extremity is poorly understood. We studied whether measurements
of skin perfusion pressure (SPP) changes by leg position and the difference between
healthy adults and patients with critical limb ischemia. The subjects of this study
were 10 healthy adults and 11 patients with critical limb ischemia. Patients with
critical limb ischemia, including both dorsum of foot and plantar of foot, having
SPP of lower limbs of less than 40 mmHg (supine position) were the object of this
study. SPP was measured on four positions (supine position, lower limbs elevation
position, sitting position, and reclining bed elevation of 20° position). In sitting
position, both the number of healthy adults and critical patients show significant
increases in SPP compared with the other three positions. These results suggest that
sitting position is effective to keep good blood stream of lower limbs not only in
healthy adults but also in patients with critical limb ischemia. However, an appropriate
leg position should not have lower limbs hang downwards for long periods time because
edema is caused by the fall in venous return in lower limbs, and the wound healing
is prolonged.
Our clinical research could be more useful in the future, particularly in developing
countries, for surgeons managing wounds in leg and foot and preserving ischemic limbs.
KEY WORDS
Critical limb ischemia - peripheral arterial disease - position - skin perfusion pressure
