Flow recovery of the micro-vessel following avulsion injury

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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.