Abstract
Background The study aims to investigate the zone of injury for major vessels after high-velocity
traumas, as it is unclear whether avoiding vascular structures is necessary during
microvascular anastomosis or how long it takes for them to be used again.
Methods This study uses Doppler ultrasonography and a rat model to evaluate the histopathological
changes and flow velocity of major vessels in the zone of injury after high-velocity
trauma with closed femoral bone fracture. Osteosynthesis was performed using an intramedullary
wire. Samples were collected from day 3 and week 3. The unaffected contralateral side
is used as control.
Results Results from arterial and venous flow assessments showed no evidence of ischemia
in the extremities. Both arteries and veins were patent in both intervals and on the
control side. The evaluation of the vessels showed arterial injury with a slightly
reduced arterial flow on day 3 and week 3. The venous flow was slightly reduced on
day 3 but not on week 3. Statistically, arterial endothelial injury was higher on
day 3 than on week 3 (p = 0.006). Media inflammation was also higher on day 3 (p = 0.06). Arterial endothelization distribution was higher in week 3 (p = 0.006). No significant differences were found in arterial media irregularity, necrosis,
platelet aggregation, bleeding, and wall rupture. Venous samples showed no significant
differences in any parameter (p < 0.05).
Conclusion High-velocity trauma increases the risk of thrombosis in vessels. Intravascular repair
can start on day 2 and continue till week 3 with significant endothelization. Although
physiologic findings do not alter arterial or venous flow, histologic findings support
vessel injuries leading to potential complications. Microsurgery should be considered
out of the injury zone until adequate vessel healing is achieved.
Keywords zone of injury - closed fracture - endothelial dysfunction
