Abstract
Ten patients with large resistant leg ulcers were treated by retrograde local pressure infusions containing 100 000 IU of urokinase three times per week for a total of 3–11 weeks. The effects of this therapy were assessed clinically, by laser Doppler flowmetry and by measurement of transcutaneous oxygen at the ulcer borders. Both methods revealed highly pathological findings before therapy, demonstrating a severe disturbance of local microcirculation in every case.
The drug is dissolved in 150 ml saline and injected into an empty leg vein while the circulation was blocked by a pressure cuff on the distal thigh for 15 min (Bier's block).
Nine patients showed an impressive clinical improvement. An increase in local skin blood flow was demonstrated by laser Doppler flowmetry, which revealed an increase in the peak flow values after release of the occlusion cuff and a shortening of the peak time with repeated injections.
The increase of transcutaneous oxygen tension with time was not statistically significant.
The beneficial effects of this therapeutic regime may be explained either by the fibrinolytic action of urokinase on intra- and extra-capillary fibrin and on blood viscosity, or by the haemodynamic changes and alterations to endothelial function caused by repeated limb occlusions.
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