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Flow recovery of the micro-vessel following avulsion injury

撕脱伤后微血管的血流恢复

基本信息

批准号：
08671399
负责人：
KAMIISHI Hiroshi
金额：
$ 1.34万
依托单位：
Kinki University Hospital
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1996
资助国家：
日本
起止时间：
1996 至 1998
项目状态：
已结题

项目摘要

It is known that the avulsed vessels are prone to cause postoperative thrombosis, which lowers the survival rate of the replanted finger. Precise mechanism of the thrombosis formation is not yet investigated, however, endothelial damage caused by the avulsion force has been suspected. In order to elucidate where and how the vessel obstruction takes place, we investigated the luminal surface of the avulsed-vessel using scanning electron microscopy. Initial result revealed the formation of extensive serial intimal ring-like cracks at and around the point of avulsion.. Further morphological study using light microscopy revealed that the cracks were the disruptions of the endothelial cell layer as well as internal elastic lamina. Deep cracks reaching media layer often generated the vulve-like projection into the lumen, where thrombus formation was found. It is concluded therefore that the avulsed-vessel demonstrates multiple intimal cracks. Cause of the vascular occlusion was considered to be the morphological alteration of the luminal surface with the serial deep cracks into the medial layer and the vulve-like projections. In the research with the diabetic rats, avulsed-vessels in the OLETF diabetic model demonstrated higher longitudinal extensibility of the vessel and the areas and depth of the multiple cracks in the luminal surface were clearly expanded. Post-avulsion vascular patency was lowered. From these results, it is concluded that the diseased vessel with diabetes mellitus has higher potency to generate thrombosis due to its fragility of the vessel structure.

众所周知，撕脱的血管容易导致术后血栓形成，从而降低再植手指的存活率。血栓形成的确切机制尚不清楚，但撕脱力引起的内皮损伤已被怀疑。为了阐明血管阻塞发生的位置和方式，我们用扫描电子显微镜观察了撕脱血管的管腔表面。初步结果显示撕脱处及其周围形成广泛的连续型内膜环状裂缝。光学显微镜下的进一步形态观察显示，裂纹是内皮细胞层和内弹力层的破坏。到达中层的深裂缝往往会向管腔内形成秃鹫状突起，并在管腔内发现血栓形成。因此，可以得出结论，撕脱的血管表现出多处内膜裂缝。血管闭塞的原因被认为是管腔表面的形态改变，内侧层有一系列的深裂缝和秃鹫状突起。在对糖尿病大鼠的研究中，OLETF糖尿病模型的撕脱血管表现出更高的血管纵向延伸性，管腔表面多处裂缝的面积和深度明显扩大。撕脱术后血管通畅率降低。从这些结果可以得出结论，糖尿病患者的病变血管由于其血管结构的脆弱性而具有更高的血栓形成能力。