Study On The Difference Of Blood Perfusion Between Keloid And Its Surrounding Skin And Its Related Factors

BackgroundKeloids are fibroproliferative lesions of unknown origin that are characterized by increased collagen deposition. Vascularization may play a role in the pathogenesis of keloids, but existing reports are contradictory. And we known little about factor which influence perfusion in keloids and surrounding skin.ObjectivesThe objectives of this study were to investigate perfusion within keloids and surrounding skin using laser speckle contrast imaging (LSCI) and relevant factors.Materials and methodsFirst stageLSCI was used to evaluate blood flow in the keloids and surrounding skin. Three regions of interest were manually defined:keloids (K), skin adjacent to keloids (A) and nonadjacent skin separated by at least 0.3 cm from the edge of the keloids (N). Mean perfusion in each of these regions was determined and ratios (K/N, A/N) were calculated.Second stageBlood perfusion, microvessel density, hypoxia inducible factor-1 α (HIF1 α), proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF) and collagen Ⅰ/Ⅲ ratio were determined in keloid and surrounding skin, including central area, marginal area, skin adjacent to keloids and nonadjacent skin. The correlation of perfusion and those factors was analyzed in this study.ResultsTwenty-one patients with 61 untreated keloids were enrolled into first stage of this study.Significantly higher perfusion was noted in keloids and adjacent skin compared with nonadjacent skin (p<0.05). The mean values (95% confidence intervals) of the ratios were:K/N=2.41 (2.28-2.54) and A/N=1.33 (1.28-1.37). A heterogeneous perfusion map was frequently observed. Mean perfusion in keloids and nonadjacent skin in the chest region was significantly higher than that on the back (p<0.05). There was no statistical significant difference in K/N at different locations (p>0.05). Six patients with 6 untreated keloids were enrolled into second stage of this study. superficial microvessel density of keloid, including central and marginal area, were significantly higher than those in adjacent and nonadjacent skin. The expressions of HIF1α, PCNA, VEGF in central and marginal area were significantly higher than those in adjacent and nonadjacent skin. The expressions of HIF1 a, VEGF and collagen Ⅰ/Ⅲ ratio in adjacent skin were higher than those in nonadjacent skin. Blood perfusion was significantly correlate with HIF1α, PCNA, VEGF and microvessel density (p<0.05).ConclusionPerfusion values in keloids and adjacent skin were significantly higher than those in nonadjacent skin. LSCI may be a suitable and useful way of assessing perfusion in keloids. Blood perfusion was significantly correlate with HIF1α, PCNA, VEGF and microvessel density, which indicated that increased perfusion in keloids might be caused by increased metabolic activity.