Subpapillary (superficial) vascular plexus

Papillary dermis · Capillary loops Blanching Stage 1 pressure injury

Horizontal arteriolar and venular network at the papillary-reticular border, fed by ascending arterioles from the deep plexus, that sends a capillary loop into every dermal papilla. Whether pressing on skin empties it is the whole basis of the blanching test.

Traced from the start

  1. Stratum basale (germinativum)
  2. Lamina densa (type IV collagen basement membrane)
  3. Subpapillary (superficial) vascular plexus

Detail

Supply
Ascending vessels from the deep dermal plexus; drains to a subpapillary venous plexus
Blanching
Erythema that blanches is blood inside these vessels; erythema that does not blanch means blood has extravasated or the microcirculation is fixed and damaged
Capillary refill
Refill after emptying this plexus should be under 2 seconds; prolongation is an early sign of hypovolaemia and of burn depth

When it goes wrong

Meningococcal or other septicaemia with extravasation of red cells

Non-blanching petechiae and purpura, which do not fade under a glass slide — an indication for immediate parenteral benzylpenicillin or ceftriaxone

Sustained pressure damaging the microcirculation over a bony prominence

Stage 1 pressure injury: non-blanchable erythema of intact skin, the earliest reversible stage

Practise this structure

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