25 Medical Products Inspired by Biological Oscillators …
395
increased perfusion pressure and hence the potential for improved wound healing
[45, 16, 6].
In terms of IPC use in venous leg ulcers a Cochrane review of nine randomised
controlled trials looked at the effects of IPC compared to no IPC, and between IPC
with and without other treatment regimens in venous ulcer management. In 4 out
of 9 studies IPC was shown to enhance the healing of venous leg ulcers suggesting
that IPC may increase the healing of venous leg ulcers compared with no compression. However it was unclear whether IPC can be used instead of compression
bandages [46].
Despite these observed clinical benefits of IPC and the exceedingly large clinical
usage of the device, there is a lack of evidence from randomised controlled trials
to establish exactly which of the impulse pressure sequences provide the greatest
therapeutic effects [79]. Whilst the mechanistic effects of IPC have predominantly
been studied locally in large vessels it is also the systemic changes in shear stress that
are likely to enhance these clinical benefits. For IPC to improve perfusion to tissue
for complications such as venous leg ulcers; to promote angiogenesis and to mitigate
the risk of DVT and pulmonary embolism it is essential that we also fully understand
the effects of IPC at a microcirculatory level, this requires further research.
In health many oscillatory mechanisms alter their periodicity to accommodate the
changing demands of life such as heart rate variability, respiratory sinus arrhythmia,
vasomotion, muscle contraction and muscle pumps. A greater understanding of the
integration of these oscillators in health along with the mechanisms induced by IPC
that generate clinical benefits in DVT, venous disease and oedema may enable us
to optimise the application of externally applied oscillatory devices to support and
enhance these mechanisms when they are compromised.
References
1. C. Aalkjaer, D. Boedtkjer, V. Matchkov, Vasomotion: what is currently thought? Acta Physiol.
202(3), 253–269 (2011)
2. Y.A. Abdulhameed, G. Lancaster, P.V.E. McClintock, A. Stefanovska, On the suitability
of laser-Doppler flowmetry for capturing microvascular blood flow dynamics from darkly
pigmented skin. Physiol. Meas. 40(7), 074005 (2019)
3. Y.A. Abdulhameed, P.V.E. McClintock, A. Stefanovska, Race-specific differences in the
phase coherence between blood flow and oxygenation: A simultaneous NIRS, white light
spectroscopy and LDF study. J. Biophotonics 13(4), e201960131 (2020)
4. A. Abu-Own, T. Cheatle, J.H. Scurr, P.D. Coleridge Smith, Effects of intermittent pneumatic
compression of the foot on the microcirculatory function in arterial disease. Eur J Vasc Surg.
7(5), 488–492 (1993)
5. K. Aizawa, S. Sbragi, A. Ramalli, P. Tortoli, F. Casanova, C. Morizzo, et al., Brachial artery
vasodilatory response and wall shear rate determined by multigate Doppler in a healthy young
cohort. J. Appl. Physiol. (1985) 124(1), 150–159 (2018)
6. U. Alpagut, E. Dayioglu, Importance and advantages of intermittent external pneumatic
compression therapy in venous stasis ulceration. Angiology 56(1), 19–23 (2005)
7. S. Baratchi, K. Khoshmanesh, O.L. Woodman, S. Potocnik, K. Peter, P. McIntyre, Molecular
sensors of blood flow in endothelial cells. Trends Mol Med. 23(9), 850–868 (2017)
395
increased perfusion pressure and hence the potential for improved wound healing
[45, 16, 6].
In terms of IPC use in venous leg ulcers a Cochrane review of nine randomised
controlled trials looked at the effects of IPC compared to no IPC, and between IPC
with and without other treatment regimens in venous ulcer management. In 4 out
of 9 studies IPC was shown to enhance the healing of venous leg ulcers suggesting
that IPC may increase the healing of venous leg ulcers compared with no compression. However it was unclear whether IPC can be used instead of compression
bandages [46].
Despite these observed clinical benefits of IPC and the exceedingly large clinical
usage of the device, there is a lack of evidence from randomised controlled trials
to establish exactly which of the impulse pressure sequences provide the greatest
therapeutic effects [79]. Whilst the mechanistic effects of IPC have predominantly
been studied locally in large vessels it is also the systemic changes in shear stress that
are likely to enhance these clinical benefits. For IPC to improve perfusion to tissue
for complications such as venous leg ulcers; to promote angiogenesis and to mitigate
the risk of DVT and pulmonary embolism it is essential that we also fully understand
the effects of IPC at a microcirculatory level, this requires further research.
In health many oscillatory mechanisms alter their periodicity to accommodate the
changing demands of life such as heart rate variability, respiratory sinus arrhythmia,
vasomotion, muscle contraction and muscle pumps. A greater understanding of the
integration of these oscillators in health along with the mechanisms induced by IPC
that generate clinical benefits in DVT, venous disease and oedema may enable us
to optimise the application of externally applied oscillatory devices to support and
enhance these mechanisms when they are compromised.
References
1. C. Aalkjaer, D. Boedtkjer, V. Matchkov, Vasomotion: what is currently thought? Acta Physiol.
202(3), 253–269 (2011)
2. Y.A. Abdulhameed, G. Lancaster, P.V.E. McClintock, A. Stefanovska, On the suitability
of laser-Doppler flowmetry for capturing microvascular blood flow dynamics from darkly
pigmented skin. Physiol. Meas. 40(7), 074005 (2019)
3. Y.A. Abdulhameed, P.V.E. McClintock, A. Stefanovska, Race-specific differences in the
phase coherence between blood flow and oxygenation: A simultaneous NIRS, white light
spectroscopy and LDF study. J. Biophotonics 13(4), e201960131 (2020)
4. A. Abu-Own, T. Cheatle, J.H. Scurr, P.D. Coleridge Smith, Effects of intermittent pneumatic
compression of the foot on the microcirculatory function in arterial disease. Eur J Vasc Surg.
7(5), 488–492 (1993)
5. K. Aizawa, S. Sbragi, A. Ramalli, P. Tortoli, F. Casanova, C. Morizzo, et al., Brachial artery
vasodilatory response and wall shear rate determined by multigate Doppler in a healthy young
cohort. J. Appl. Physiol. (1985) 124(1), 150–159 (2018)
6. U. Alpagut, E. Dayioglu, Importance and advantages of intermittent external pneumatic
compression therapy in venous stasis ulceration. Angiology 56(1), 19–23 (2005)
7. S. Baratchi, K. Khoshmanesh, O.L. Woodman, S. Potocnik, K. Peter, P. McIntyre, Molecular
sensors of blood flow in endothelial cells. Trends Mol Med. 23(9), 850–868 (2017)