Neurovascular Interrelations and Tissue Microcirculation in Posttraumatic Reflex Sympathetic Dystrophy

Thirty eight patients with posttraumatic reflex sympathetic dystrophy (RSD) of upper extremities and 28 healthy individuals of the same age (control group) were examined using computer laser doppler flowmetry (LDF) and wavelet-analysis of amplitude-frequency spectrum of fluctuations of microvascular circulation. RDS prevailed in patients with primary warm forms, increase ofportion of shunt circulation, decrease of sympathetic activity and its breakdown at activation. Patients with primary cold forms were characterized by inconstant increase of neurogenic tonus of microvessels at rest. Prolong activation of peptidergenic function of sensory fibres supporting neurogenic inflammation, edema and pain syndrome were typical. One could not exclude that sympathetic vasomotor function and sympathetic support of pain may innervated by different groups of sympathetic neurons. Objective assessment of perivascular innervation and tissue microcirculation is of great clinical importance for individual RSD treatment protocol. Use of LDF is reasonable for early diagnosis of RSD, determination the role of sympathetic and peptidergenic mechanisms in RSD pathogenesis and indications for sympathetic blockades and capsaicin.