Ernst S. Smits, Msc. and Liron S. Duraku, Msc, contributed equally to this work.
Letter to the Editor
Comments to the term “cold-induced vasodilatation” in “laser doppler perfusion imaging of skin territory to reflect autonomic functional recovery following sciatic nerve autografting repair in rats”
Article first published online: 13 SEP 2012
Copyright © 2012 Wiley Periodicals, Inc.
Volume 33, Issue 1, pages 83–84, January 2013
How to Cite
Smits, E. S., Duraku, L. S., Niehof, S. P., Kusters, F. J., Hovius, S. E.R., Daanen, H. A.M., Selles, R. W. and Walbeehm, E. T. (2013), Comments to the term “cold-induced vasodilatation” in “laser doppler perfusion imaging of skin territory to reflect autonomic functional recovery following sciatic nerve autografting repair in rats”. Microsurgery, 33: 83–84. doi: 10.1002/micr.22026
- Issue published online: 18 JAN 2013
- Article first published online: 13 SEP 2012
- Manuscript Accepted: 22 JUN 2012
- Manuscript Received: 8 MAY 2012
In this letter, we would like to challenge the correctness of the term cold-induced vasodilatation (CIVD) in a recent paper in this journal.1 The group of Hu et al.1 contributed to the debate on the influence of nerve injury and nerve repair on the CIVD reaction. The study reported a significant decrease in the CIVD reaction of the hind paw following a nerve transection of the sciatic nerve as compared to a sham-treated group (same operation procedure, without nerve manipulation). In addition, they measured the CIVD reaction after an autograft repair of the sciatic nerve and found no significant differences with the sham-treated group. Therefore, the authors concluded that the CIVD reaction is controlled by the nervous system, more specifically, by the autonomic nervous system. In this reply, we question if Hu et al. use the definition of a CIVD in an accurate manner. It is possible that the CIVD reaction defined and measured by Hu et al. was not a CIVD reaction but an active rewarming pattern.
A CIVD is currently defined as a cyclic oscillation in blood flow that occurs in extremities on cold exposure.2–4 The study of Hu examined the CIVD reaction by placing the hind paws in smashed ice for 5 minutes, thereafter immediately drying them with a towel and measuring blood perfusion by means of a laser Doppler. However, measuring the CIVD when the cooling phase has ended is not in line with the current definition which states that a CIVD reaction presents on cold exposure. As there is no active cooling, we believe that it is better characterized as rewarming.
A second argument why the pattern reported by Hu et al. is not a CIVD is the course of blood perfusion. The study shows that after the cooling phase, a vasodilatory response occurs in the first minutes, which stabilizes after ±10 minutes. Afterward, neither vasodilation nor vasoconstriction occurs for up to 20 minutes. As a CIVD is a clear cyclic oscillation in blood flow induced by subsequent vasoconstrictions and vasodilatation, we believe that the findings by Hu et al. are not CIVD reactions but are active rewarming patterns. In a recent study,5 we demonstrated that active rewarming due to vasodilatation occur after a period of cold exposure and that this active rewarming can be disturbed in patients with peripheral nerve injury,6 which is in line with the results of Hu et al.
There are methods that permit simultaneous cooling and measuring blood perfusion or skin temperature, which would allow for measuring CIVD in animal experiments. However, there is still no clear definition of a CIVD reaction in humans and animals, which makes comparing studies very difficult. To avoid confusion, we propose to limit the term CIVD to vasodilation during local cold exposure and not after cold exposure,7–9 which is a commonly respected definition.4
- 1Laser doppler perfusion imaging of skin territory to reflect autonomic functional recovery following sciatic nerve autografting repair in rats. Microsurgery 2012; 32: 136–143., , , , , , .
- 2Cold-induced vasodilation. Eur J Appl Physiol 2009; 105: 663–664..
- 3Cold-induced vasodilatation in isolated, perfused rat tail artery. Am J Physiol 1986; 251: H176–H181., .
- 4Observation upon the reactions of the vessels of the human skin to cold. Heart 1930; 15: 177–208..
- 5Thermoregulation in peripheral nerve injury-induced cold-intolerant rats. J Plast Reconstr Aesthet Surg 2012; 65: 771–779., , , , , .
- 6Digital rewarming patterns after median and ulnar nerve injury. J Hand Surg Am 2009; 34: 54–64., , , , , .
- 7Dynamic adaptation of the peripheral circulation to cold exposure. Microcirculation 2012; 19: 65–77., .
- 8“cold-induced vasodilation.” Eur J Appl Physiol 2010; 108: 215–216., , Reply to and reply letter regarding
- 9Neural influence on cold induced vasodilatation using a new set-up for bilateral measurement in the rat hind limb. J Neurosci Methods 2010; 193: 100–105., , .
Ernst S. Smits M.Sc.*, Liron S. Duraku M.Sc.*, Sjoerd P. Niehof Ph.D., Freek J. Kusters M.D.*, Steven E.R. Hovius M.D., Ph.D.*, Hein A.M. Daanen Ph.D. §, Ruud W. Selles Ph.D.¶, Erik T. Walbeehm M.D., Ph.D.*, * Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, Pain Treatment Center, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands, § TNO Behavioural and Societal Sciences, Soesterberg, The Netherlands, ¶ Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.