fibrin and Amputation--Traumatic

The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis.. 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding.. Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group.. The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.

Topics: Adult; Amputation, Traumatic; Angiography; Contrast Media; Crush Injuries; Degloving Injuries; Edema; Female; Fibrin; Finger Injuries; Fingers; Fluoroscopy; Hemorrhage; Hernia; Humans; Male; Microscopy; Middle Aged; Prospective Studies; Regional Blood Flow; Triiodobenzoic Acids

The outcome of peripheral nerve injury is often impaired by neuropathic pain, which is resistant to most analgesics and presents a serious clinical problem. The mechanisms underlying post-traumatic neuropathic pain remain unclear, but they are likely associated with the regeneration processes. Brain-derived neurotrophic factor (BDNF) is known to enhance peripheral nerve regeneration and is also considered to be an endogenous modulator of nociceptive responses following spinal cord lesion. The aim of this work was to examine the local effect of BDNF in a neuropathic pain model. Sciatic nerves of adult male rats were transected and supplied with connective tissue chambers filled with (1) fibrin only, (2) fibrin with BDNF, or (3) fibrin with antibodies against BDNF. In control animals the nerve was transected and no chamber was applied. During follow-up, autotomy behavior was assessed. Seven weeks after the operation, the number of surviving and regenerating neurons in dorsal root ganglia was counted and the neuroma incidence was examined. We found that local inactivation of BDNF decreased the incidence as well as severity of autotomy and neuroma formation, but did not influence neuron regeneration into the chambers. These results indicate that BDNF plays a locally crucial role in neuropathic pain development after peripheral nerve injury.

Topics: Amputation, Traumatic; Animals; Antibodies, Blocking; Behavior, Animal; Brain-Derived Neurotrophic Factor; Fibrin; Fibrinogen; Ganglia, Spinal; Male; Nerve Regeneration; Neuroma; Neurons; Pain; Peripheral Nervous System Diseases; Peripheral Nervous System Neoplasms; Rats; Rats, Wistar; Sciatic Neuropathy; Thrombin