Evaluation of the Extent of Vessel Avulsion Injury: An Experimental Study Using a Rabbit Model

Abstract

Background Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury.

Methods Varying degrees of avulsion were applied to the aorta of 12 (n = 12) adult female New Zealand rabbits. Avulsion was first determined using adventitial findings and then with endothelial findings. The definitive extent of damage was determined histopathologically.

Results The mean area of the histopathological sections was 16.7 ± 6.9 mm. The extent of damage measured from the adventitia was 15.8 ± 7.9 mm (the difference in histopathological examinations was not significant, p = 0.590, paired t-test), while the extent of damage from the lumen was 13.3 ± 8.2 mm (the difference in histopathological examinations was significant p = 0.004, paired t-test).

Conclusion Excision based on adventitia findings is more effective in case of avulsion injury.

Keywords

avulsion - adventitia - endothelium - vessel - injury

• References

• 1 Ozerkan F, Ada S, Bora A, Kaplan I, Ademoglu Y. Eight years experience in crush and avulsion type finger amputation. Microsurgery 1995; 16 (11) 739-742
• 2 Gülgönen A, Bayri O, Ozkan T, Güdemez E. Replantation of thumb avulsion injuries. Handchir Mikrochir Plast Chir 2007; 39 (04) 231-237
• 3 Lykoudis EG, Panayotou PN, Stamatopoulos CN, Frangia KB, Papalois AE, Ioannovich JD. Microvascular repair following a modified crush-avulsion injury in a rat model: effect of recombinant human tissue-type plasminogen activator on the patency rate. Microsurgery 2000; 20 (02) 52-58
• 4 Mitchell GM, Morrison WA, Papadopoulos A, O'Brien BM. A study of the extent and pathology of experimental avulsion injury in rabbit arteries and veins. Br J Plast Surg 1985; 38 (02) 278-287
• 5 Cooley BC, Hansen FC. Microvascular repair following local crush and avulsion vascular injury. Microsurgery 1985; 6 (01) 46-48
• 6 Fu K, Izquierdo R, Hubbard T, Fareed J. Modified crush-avulsion anastomosis model on the rat femoral vein. Microsurgery 1995; 16 (08) 536-541
• 7 Merle M, Dautel G. Advances in digital replantation. Clin Plast Surg 1997; 24 (01) 87-105
• 8 Glover MG, Seaber AV, Urbaniak JR. Arterial intimal damage in avulsion and crush injuries in rat limbs. J Reconstr Microsurg 1985; 1 (04) 247-251
• 9 Kupfer DM, Eaton C, Swanson S, McCarter MK, Lee GW. Ring avulsion injuries: a biomechanical study. J Hand Surg Am 1999; 24 (06) 1249-1253
• 10 Pomerance J, Truppa K, Bilos ZJ, Vender MI, Ruder JR, Sagerman SD. Replantation and revascularization of the digits in a community microsurgical practice. J Reconstr Microsurg 1997; 13 (03) 163-170
• 11 Linton RR. Some practical considerations in the surgery of blood vessel grafts. Surgery 1955; 38 (05) 817-834
• 12 Gravvanis AI, Tsoutsos DA, Lykoudis EG. , et al. Microvascular repair following crush-avulsion type injury with vein grafts: effect of direct inhibitors of thrombin on patency rate. Microsurgery 2003; 23 (04) 402-407 , discussion 408–409
• 13 Molski M. Replantation of fingers and hands after avulsion and crush injuries. J Plast Reconstr Aesthet Surg 2007; 60 (07) 748-754
• 14 Uraloğlu M, Orbay H, Livaoğlu M, Aydın N, Saraç N, Alagöz S. An objective evaluation of an injured vessel wall using fluorescein sodium before microvascular anastomosis in an experimental rat model. J Reconstr Microsurg 2011; 27 (05) 321-326
• 15 Zeeman BJ, Mitchell GM, Olazabal AE, Collopy PA, Morrison WA, O'Brien BM. The significance of resection length on the patency rate, and the histopathology, of experimentally avulsed and microsurgically repaired blood vessels. Br J Plast Surg 1988; 41 (05) 509-514
• 16 Mitchell GM, Frykman GK, Morrison WA, O'Brien BM. The nature and extent of histopathologic injury in human avulsed arteries and veins and in experimentally avulsed monkey arteries. Plast Reconstr Surg 1986; 78 (06) 801-810
• 17 Jia YC, Chen HH, Kang QL, Chai YM. Stimulation of nitric oxide production contributes to the antithrombotic effect of stromal cell-derived factor-1α in preventing microsurgical anastomotic thrombosis. J Reconstr Microsurg 2016; 32 (06) 470-475
• 18 Adani R, Pataia E, Tarallo L, Mugnai R. Results of replantation of 33 ring avulsion amputations. J Hand Surg Am 2013; 38 (05) 947-956
• 19 Van Beek AL, Kutz JE, Zook EG. Importance of the ribbon sign, indicating unsuitability of the vessel, in replanting a finger. Plast Reconstr Surg 1978; 61 (01) 32-35
• 20 Hyza P, Vesely J, Drazan L, Stupka I, Ranno R, Castagnetti F. Primary vein grafting in treatment of ring avulsion injuries: a 5-year prospective study. Ann Plast Surg 2007; 59 (02) 163-167
• 21 Yates YJ, Farias CL, Kazmier FR, Puckett CL, Concannon MJ. The effect of tirofiban on microvascular thrombosis: crush model. Plast Reconstr Surg 2005; 116 (01) 205-208
• 22 Hassanpour SE, Tarahomi M, Daryani A. Thrombosis prevention with botulinum toxin a after traumatic crush injury in a rat model. J Reconstr Microsurg 2018; 34 (03) 206-210