Impaired Oxygen Utilization in Skeletal Muscle of CRPS I Patients

• Published in: The Journal of surgical research Vol. 173; no. 1; pp. 145 - 152
• Main Authors: Tan, Edward C.T.H., Ter Laak, Henk J., Hopman, M.T.E., van Goor, H., Goris, R. Jan A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2012
• Subjects: Adolescent; Adult; Amputation; Basement Membrane - ultrastructure; Capillaries - pathology; Capillaries - ultrastructure; Chronic Disease; complex regional pain syndrome; Female; Humans; Leg - surgery; Male; Middle Aged; Muscle Fibers, Skeletal - metabolism; Muscle Fibers, Skeletal - pathology; Muscle Fibers, Skeletal - ultrastructure; Muscle, Skeletal - blood supply; Muscle, Skeletal - metabolism; Muscle, Skeletal - pathology; Oxygen - metabolism; oxygen extraction; Reflex Sympathetic Dystrophy - metabolism; Reflex Sympathetic Dystrophy - pathology; skeletal muscle; Surgery; Young Adult; oxygen metabolism; amputation; complex regional pain syndrome; skeletal muscle; oxygen extraction
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2010.08.043

The purpose of this study was to evaluate oxygen extraction and utilization in end stage chronic complex regional pain syndrome type I (CRPS I) patients undergoing amputation and to relate these to muscle histology of the amputated limb. In 25 patients with severe CRPS I requiring amputation of the affected limb venous blood samples and in 11 patients skeletal muscle specimens were analyzed. The mean venous oxygen saturation (SvO2) value (94.3% ± 4.0%) of the affected limb was significantly higher than SvO2 values found in healthy subjects (77.5% ± 9.8%) pointing to a severely decreased oxygen diffusion or utilization within the affected limb. Histologic analysis showed a significant decrease of type I fibers and a significant increase of type IIB fibers. Ultrastructural investigations of soleus skeletal muscle capillaries revealed thickened endothelial cells and thickened basement membranes. Muscle capillary densities were decreased in comparison with literature data. High venous oxygen saturation levels were partially explained by impaired diffusion of oxygen due to thickened basement membrane and decreased capillary density. This study shows that venous oxygen saturation is significantly increased in chronic end stage CRPS I patients corresponding with impaired oxygen diffusion. The abnormal skeletal muscle findings points to severe disuse but only partially explain the impaired diffusion of oxygen; mitochondrial dysfunction seems a likely explanation in addition.