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Le Ulcere | La fisopatologia dell'ulcera venosa > --- Physiopathological differences in the onset of oedema or ipodermithis/ulcer in superficial venous insufficiency
In the superficial venous insufficiency oedema is more common on the outside of the leg, and hypodermitis and ulcers are more frequent on the inside.

edema Stefano Ermini

Physiopathological differences in the onset of oedema or ipodermithis/ulcer in  superficial venous insufficiency


 


Ermini Stefano


 


In the superficial venous insufficiency oedema is more common on the outside of the leg, and hypodermitis and ulcers are more frequent on the inside.


There are several elements that are experiencing this change in incidence, such as the trophism of the region, the presence of lymphatic vessel  and muscle-pump activity, and  it is of the latter activity that is focused in this document that would like to present a phisiopathological ipothesys.


The edema is due to an increase in TMP, hypodermitys and ulcers to the passage in the connective tissue of red blood cells and other macromolecules that occur following the breakage of the endothelium, for example by a fast increasing pressure trauma.


An incompetent  saphenous system is characterized by an retrograde flow during muscle diastole, and an arrest of retrograde flow or appearance of antegrade flow (ie reverse direction), during muscle systole.


Kinetic energy and lateral pressure are complementary and go hand in hand ( ). Kinetic energy in diastolic flow depends on the height of the column of blood ,the type of shunt and the re-entry points.


The presence of efficient re-entry points determine the retrograde diastolic flow velocity and increases the lateral pressure that occurs when, with the muscular systole, retrograde flow stops or changes the direction.


In case of efficient re-entry points we would have low lateral pressure during diastole and a peak of lateral pressure during the passage from diastole to systole.








 

In case of a non efficient re-entry point the retrograde diastolic flow velocity will be less as  less will be the peak of lateral pressure in the passage diastole - systole. Therefore we will have a greater lateral pressure (and therefore more TMP) during any stage of diastolic retrograde flow.


The average increase in TMP can facilitate an oedema.


The peak lateral pressure in the process of shutting down the diastolic flow generates an injury on the endothelium, facilitating ulcers.


This then explains why the presence of efficient re-entry points facilitate ulcers and non efficient re-entry points are associated with oedema


 


 


 


 


Bibliography:


1)      S.B. Curri: Le Microangiopatie, II° Edizione, Inverni della Beffa 1986


2)      Raffetto JD, Martson WA: Venous Ulcer: what is new?, Plast Reconstr Surg 2011 Jan;127 Suppl 1:279S-288S.


3)      Adamson RH et al.: Oncotic pressures opposing filtration across non-fenestrated rat microvessels. J Physiol. 2004 Jun 15;557(Pt 3):889-907. Epub 2004 Apr 8.


4)      Delis KT  et al : Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency. J Vasc Surg. 1998 Nov;28(5):815-25.


5)      C.Franceschi: Theorie et pratique de la cure CHIVA, Edition de l'Amarcon 1988




· Scarica il file PDF: Phisiopatholgy of oedema or ipodermithis .pdf
Physiopathological differences in the onset of oedema or ipodermithis/ulcer in superficial venous insufficiency
In the superficial venous insufficiency oedema is more common on the outside of the leg, and hypodermitis and ulcers are more frequent on the inside.
There are several elements that are experiencing this change in incidence, such as the trophism of the region, the presence of lymphatic vessel and muscle-pump activity, and it is of the latter activity that is focused in this document that would like to present a phisiopathological ipothesys.
The edema is due to an increase in TMP, hypodermitys and ulcers to the passage in the connective tissue of red blood cells and other macromolecules that occur following the breakage of the endothelium, for example by a fast increasing pressure trauma.
An incompetent saphenous system is characterized by an retrograde flow during muscle diastole, and an arrest of retrograde flow or appearance of antegrade flow (ie reverse direction), during muscle systole.
Kinetic energy and lateral pressure are complementary and go hand in hand ( ). Kinetic energy in diastolic flow depends on the height of the column of blood ,the type of shunt and the re-entry points.
The presence of efficient re-entry points determine the retrograde diastolic flow velocity and increases the lateral pressure that occurs when, with the muscular systole, retrograde flow stops or changes the direction.
In case of efficient re-entry points we would have low lateral pressure during diastole and a peak of lateral pressure during the passage from diastole to systole.
In case of a non efficient re-entry point the retrograde diastolic flow velocity will be less as less will be the peak of lateral pressure in the passage diastole - systole. Therefore we will have a greater lateral pressure (and therefore more TMP) during any stage of diastolic retrograde flow.
The average increase in TMP can facilitate an oedema.
The peak lateral pressure in the process of shutting down the diastolic flow generates an injury on the endothelium, facilitating ulcers.
This then explains why the presence of efficient re-entry points facilitate ulcers and non efficient re-entry points are associated with oedema
[continua >>]

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