Pathophysiological process of traumatic vascular spasm in multiple crush injury.

Despite recent advances in microsurgery, the incidence of thrombosis of repaired digital vessels following crush injury is higher than that of uncrushed arteries. The purpose of this study was to evaluate the effects of traumatic crush injury on uncrushed segments of artery adjacent to crushed segments. Sprague-Dawley rat-tail arteries were crushed for 1 hour by 30 pounds of force at two separate 3-mm-wide segments, with 10 mm of uncrushed artery between segments. Luminal size of the uncrushed segments decreased progressively over the first 12 hours, with a significant reduction by 4 hours postcrush. The condition of the arteries continued to deteriorate until, by 24 hours postinjury, they had been denuded of endothelium, and smooth muscle damage had occurred. Untreated vasospasm following a multiple-level crush injury therefore results in progressive endothelial and intimal damage and thrombosis in the intervening healthy uncrushed segments of artery. This article discusses the implications of these findings.