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57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

German Society for Neuropathology and Neuroanatomy

12. - 15.09.2012, Erlangen

57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

The Modified Procedure and its Experimental study Treating the Compartment Syndrome as well as the established Volkmmann contracture

Meeting Abstract

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  • presenting/speaker Xiaogang Wang - Tianjin Hospital, Hand and Microsurgery, City of Tianjin, China

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie. 57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN). Erlangen, 12.-15.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgnnPP1.3

DOI: 10.3205/12dgnn021, URN: urn:nbn:de:0183-12dgnn0211

Published: September 11, 2012

© 2012 Wang.
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Outline

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Question: To investigate the course of neuromuscular junction's pathological changes during complete ischemia-reperfusion in skeletal muscle.Therefore,clinical work is expected to benefit from some aspects of this study.

Methods: 1.48 Wistar rats were randomised into 6 groups.Group A,control.B,2 hours clamp ischemia to the right hindlimb.C,4h ischemia.D,4h ischemia followed by 2h reperfusion.E,4h ischemia followed by 24h reperfusion. F,4h ischemia followed by 2 weeks reperfusion. 2.Parameters of muscle were observed.Muscle harvested were stained with AuCL3 and succinate dehydrogenase combined with acetylcholine esterase respectively.3.From 2003 to 2011, I applied extensive debridement of necrotic portion within muscle to 13 patients suffered from compartment syndrome or Volkmann's contracture,meanwhile I applied fasciotomy to only one patient.

Results: 1.Experimental results:1.1 muscle of Group B and C showed the colour of pink without any edema.The contracture and dysfunction of elasticity and contractility became even worse in Group C .After reperfusion,the performance( pink and edema) of muscle seemed to get better while the function of elasticity and contraction got almost the same as before,even worse.At last the yellow necrotic tissue expose and almost lost all its functions. 1.2.AuCL3 staining and Enzymhistochemistry assay:Necrosis of myocytes was followed by degeneration of their NMJs,finally nerve fibers attached to these NMJs were disrupted as same as withering of leaves. 2.Clinical results:The patients applied with the extensive debridement got primary incision healing.They obtained much better short-term and long-term functions than that ones just applied with fasciotomy.

Conclusion: 1.NMJ is disrupted rapidly during reperfusion,but it seemed that degeneration of NMJ is slower and later than that of myocyte.And finally NMJ and nerve fiber attached to necrotic myocytes are substituted completely with granulation in the zone injured. 2. I assume that there are two vicious circles existing in the pathological mechanics of the compartment syndrome. The patients applied with debridement upon muscles got pretty good function.The majority of patients obtained primary incision healing.