Increased S-100 B levels are associated with fractures and soft tissue injury in multiple trauma patients.

BACKGROUND: S-100 B protein was identified as a biomarker for traumatic brain injury, but studies suggest that extracranial injuries may also lead to increased S-100 B serum levels. In this study, we aim to quantify the impact of injury patterns on S-100 B levels in patients with suspected multiple trauma. METHODS: Patients with suspected multiple trauma treated at a Level 1 Trauma centre in Switzerland were included in this retrospective patient chart review. Extent of injuries and severity was assessed and S-100 B levels on admission measured. Potential predictors of increased S-100 B levels (>0.2 µg/L) were identified through uni- and multivariable analyses. RESULTS: In total, 1,338 patients with suspected multiple trauma were included. Multivariable logistic regression showed a significant association with increased S-100 B levels in long bone fracture (OR 2.3, 95% CI: 1.3-4.1, p = 0.004), non-long bone fracture (OR 3.0, 95% CI: 2.2-4.3, p<0.001), thoracic injury (OR 2.6, 95% CI: 1.6-4.2, p<0.001), and deep tissue injury/wounds (OR 1.9, 95% CI: 1.4-2.6, p<0.001). Head trauma with intracerebral bleeding was only weakly associated (OR 2.0, 95% CI 1.2-3.5, p = 0.01) and head trauma without intracranial bleeding was not associated with an increased S-100 B protein level (p = 0.71). Trauma severity was also related to increased S-100 B levels (OR per ISS: 1.1, 95% CI 1.0-1.1, p<0.001). S-100 B levels <0.57 µg/L had a high diagnostic value to rule out in-hospital mortality (negative predictive value: 1.0, 95% CI: 0.98-1.00). CONCLUSION: Fractures and thoracic injuries appeared as main factors associated with increased S-100 B levels. Head injury may only play a minor role in S-100 B protein elevation in multiple trauma patients. A normal S-100 B has a good negative predictive value for in-hospital mortality. S100-B levels were associated with trauma severity and might thus be of use as a prognostic marker in trauma patients.

Protective Effects of Resveratrol Supplementation on Contusion Induced Muscle Injury.

Muscle injuries frequently occur in contact sports events. The current treatment options for soft tissue injuries remain suboptimal and often result in delayed or incomplete recovery of damaged muscles. Resveratrol (RES) is a phenolic phytochemical, well-known for its antioxidant and anti-inflammatory properties. The purpose of this study is to evaluate the potential beneficial effects of RES supplementation on inflammation and regeneration in skeletal muscle after a contusion injury, in comparison to a conventional treatment of nonsteroidal anti-inflammatory drugs (NSAID). After one week of acclimation, forty eight -week-old male ICR mice were randomly divided into the five groups (n=8 per group): 1) normal control (NC), 2) mass-drop injury without any treatment (mass-drop injury, MDI), 3) post-injury NSAID treatment (MDI+ 10mg/kg NSAID), 4) post-injury RES supplementation (MDI+ 25mg/kg/day RES) and 5) post-injury treatment with RES and NSAID (MDI + resveratrol+ NSAID). After muscle contusion injury of the left gastrocnemius muscle, RES or NSAID were orally administered post-injury once a day for 7 days. Results showed that the MDI group had significantly higher serum uric acid (UA), CREA (creatinine), LDH (lactic dehydrogenase) and creatine kinase (CK) than the normal control group. Treatment with resveratrol reduced muscle damage as evidenced by the significantly decreased serum levels of UA, CREA, LDH and CK after contusion-induced muscle injuries in mice. In addition, RES and RES + NSAID groups promoted muscle satellite cell regeneration with increase in desmin protein after injury. Our results suggest that resveratrol combined with NSAID potentially improve muscle recovery and may be a potential candidate for further development as an effective clinical treatment for muscle repair.

Alleviation Effects and Mechanisms of Low-intensity Focused Ultrasound on Pain Triggered by Soft Tissue Injury.

OBJECTIVES: Pain caused by soft tissue injury (STI) is always intractable and will eventually result in physical and psychological problems. This experiment aimed to assess the efficacy and mechanisms of low-intensity focused ultrasound (LIFU) for pain-related STI. METHODS: Rabbits (n = 30) with STI were given fixed treatment for 20 seconds and then mobile treatment for 60 seconds daily for 10 consecutive days by an LIFU device with a power output of 5 to 6 W and a frequency of 0.8 MHz. To evaluate the degree of pain, the levels of ß-endorphin in serum were measured by an enzyme-linked immunosorbent assay before and 5 to 10 minutes after the 1st, 3rd, 7th, and 10th treatments. The pain threshold was measured by an electronic analgesy meter on the 1st, 3rd, 7th, 10th, 17th, and 24th days after the start of the treatment. To investigate inflammation, prostaglandin E2 , interleukin-1ß, and 5-hydroxytryptamine levels were detected by an enzyme-linked immunosorbent assay, and nuclear factor κB messenger RNA levels were determined by a real-time quantitative polymerase chain reaction at the same time as the pain threshold was tested. RESULTS: Compared with non-LIFU groups, ß-endorphin levels and pain thresholds were significantly increased (P < .05), whereas nuclear factor- κB messenger RNA, prostaglandin E2 , interleukin- 1ß, and 5-hydroxytryptamine levels were significantly reduced (P < .05) after LIFU treatment in rabbits with STI. CONCLUSIONS: Low-intensity focused ultrasound can alleviate pain induced by STI and could have further clinical applications.

Comparison of serum markers for muscle damage, surgical blood loss, postoperative recovery, and surgical site pain after extreme lateral interbody fusion with percutaneous pedicle screws or traditional open posterior lumbar interbody fusion.

BACKGROUND: The benefits of extreme lateral interbody fusion (XLIF) as a minimally invasive lumbar spinal fusion treatment for lumbar degenerative spondylolisthesis have been unclear. We sought to evaluate the invasiveness and tolerability of XLIF with percutaneous pedicle screws (PPS) compared with traditional open posterior lumbar interbody fusion (PLIF). METHODS: Fifty-six consecutive patients underwent open PLIF and 46 consecutive patients underwent single-staged treatment with XLIF with posterior PPS fixation for degenerative lumbar spondylolisthesis, and were followed up for a minimum of 1 year. We analyzed postoperative serum makers for muscle damage and inflammation, postoperative surgical pain, and performance status. A Roland-Morris Disability Questionnaire (RDQ) and Oswestry Disability Index (ODI) were obtained at the time of hospital admission and 1 year after surgery. RESULTS: Intraoperative blood loss (51 ± 41 ml in the XLIF/PPS group and 206 ± 191 ml in the PLIF group), postoperative WBC counts and serum CRP levels in the XLIF/PPS group were significantly lower than in the PLIF group. Postoperative serum CK levels were significantly lower in the XLIF/PPS group on postoperative days 4 and 7. Postoperative recovery of performance was significantly greater in the XLIF/PPS group than in the PLIF group from postoperative days 2 to 7. ODI and visual analog scale (VAS) score (lumbar) 1 year after surgery were significantly lower in the XLIF/PPS group compared with the PLIF group. CONCLUSIONS: The XLIF/PPS procedure is advantageous to minimize blood loss and muscle damage, with consequent earlier recovery of daily activities and reduced incidence of low back pain after surgery than with the open PLIF procedure.

Posterolateral vs Direct Anterior Approach in Total Hip Arthroplasty (POLADA Trial): A Randomized Controlled Trial to Assess Differences in Serum Markers.

BACKGROUND: The direct anterior approach (DAA) for total hip arthroplasty has claimed to be a true tissue-sparing minimally invasive approach that has less tissue damage and a faster recovery when compared to the posterolateral approach (PLA). The aim of this randomized controlled trial is to measure the differences in serum markers and functional outcomes between the DAA and PLA for total hip arthroplasty. METHODS: Forty-six patients were prospectively included and randomized for either the DAA (n = 23) or PLA (n = 23). All surgical procedures were performed by 3 well-trained orthopedic surgeons. The degree of tissue damage was assessed by measuring creatine kinase (CK) and C-reactive protein levels (CRP) preoperatively and 2 hours, 1 day, 2 weeks, and 6 weeks postoperatively. Generalized linear mixed models analyses were used to assess differences between serum markers over time; correction for possible confounding factors was performed. The Hip disability and Osteoarthritis Outcome Score and the Harris Hip Score were assessed preoperatively and 6 weeks postoperatively. RESULTS: There were no differences in patient demographics. The DAA had a longer operative time (P = .001). CK and CRP levels increased postoperatively, but no significant differences between the groups were found on any of the time points. Functional outcomes were also similar in both approaches. CONCLUSION: No difference in tissue damage measured with serum markers CK and CRP were found between the DAA and PLA for total hip arthroplasty.

Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque).

BACKGROUND: Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, whereas tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a nonhuman primate (NHP) model. METHODS: NHPs were randomized to three injury groups (n = 8/group): 60 minutes severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++). Animals were resuscitated and monitored for 360 minutes. Blood samples were collected at baseline, end-of-shock, end-of-resuscitation (EOR), and T = 360 minutes for assessments of: severity of shock (lactate) and coagulation via prothrombin time, partial thromboplastin time, D-dimer, fibrinogen, antithrombin-III, von Willebrand factor, and viscoelastic testing (ROTEM). Results are reported as mean ± SEM; statistics: two-way analysis of variance and t-tests (significance: p < 0.05). RESULTS: Blood loss, prothrombin time, partial thromboplastin time, antithrombin-III, fibrinogen, and von Willebrand factor were equivalent among groups and viscoelastic testing revealed few differences throughout the study. D-dimer increased approximately threefold, at EOR in the HS group, and at T = 360 minutes in the HS+ and HS++ groups (p < 0.05). At EOR, in the HS group compared with the HS+ and HS++ groups; the D-dimer-lactate ratio was twofold greater (2.2 ± 0.3 vs. 1.1 ± 0.3 and 1.1 ± 0.2, respectively; p < 0.05) and tissue factor-activated fibrin clot 30-minute lysis index was lower (98 ± 1% vs. 100 ± 0% and 100 ± 0%, respectively; p < 0.05). CONCLUSION: NHPs in HS exhibit acute suppression of fibrinolysis in the presence of tissue injury. Additional assessments to more comprehensively evaluate the mechanisms linking tissue injury with the observed fibrinolysis shutdown response are warranted.

Markers of muscle damage for comparing soft tissue injury following proximal femur nail and dynamic hip screw operations for intertrochanteric hip fractures.

BACKGROUND: Femoral neck fractures are the most common fractures among the elderly. The two operative approaches used for the treatment of AO/OTA 31 intertrochanteric fractures include an intramedullary device (proximal femoral nail [PFN]) or an extramedullary device (sliding/dynamic hip screw [DHS]). The aim of this study was to provide objective evidence of local soft tissue injury by measuring serum creatine phosphokinase (CPK), a biochemical marker, to quantify muscle damage and inflammation in patients treated by the two approaches. PATIENTS AND METHODS: Medical data of 359 patients operated for intertrochanteric fractures with PFN (156 patients) or DHS (193 patients) were retrospectively reviewed. The fractures were classified according to AO/OTA classification. Perioperative and radiographic data were collected to ensure cohorts with similar characteristics. Serum CPK and serum hemoglobin (Hb) levels were measured preoperatively and on postoperative day 1 (POD1). Independent predictors of elevation in the levels of markers of inflammation and muscle damage were determined by a multivariate linear regression model. RESULTS: The demographics were similar for the two groups. Our study population included 64.2% female patients. Preoperative serum CPK levels were available for 89 patients and POD1 serum CPK levels were available for all patients. One-hundred and thirteen of the 193 DHS patients (58%) and 14 of the 156 PFN patients (9%) had a stable fracture (AO/OTA 31A1, p<0.0001). The DHS patients had a greater increase between pre- and postoperative CPK levels compared to the PFN patients (DHS, δ=368 versus PFN, δ=65, p<0.0002). The PFN patients had a greater decrease in both the pre- and postoperative Hb levels compared to the DHS patients (Diff_Hb 0.27g/dl). The older the patient, the greater decreases in Diff_CPK compared to the younger ones. CONCLUSIONS: Implementation of POD1 CPK blood levels as a biochemical marker of soft tissue injury provided quantitative evidence that patients whose intertrochanteric fracture was stabilized by a DHS suffered greater soft tissue injury compared to patients whose fracture was stabilized by a PFN.

Quantitative analysis of tissue injury after minimally invasive total hip arthroplasty.

BACKGROUND: We intended to clarify the hypothesis that minimally invasive total hip arthroplasty (MI-THA) leads to less tissue damage and inflammatory response than does conventional total hip arthroplasty (C-THA). METHODS: We performed 30 cases of THA between September 2005 and May 2006 and evaluated these cases prospectively. We chose 15 MI-THA cases for the study group and another 15 C-THA cases for the control group. We checked skeletal muscle marker enzymes, such as serum creatinine kinase and aldolase, the pro-inflammatory cytokines, interleukin (IL)-6 and 8, and the anti-inflammatory cytokines, IL-10 and IL-1 receptor antagonist (ra) the day before surgery and at postoperative days 1, 7, and 14. RESULTS: On postoperative days 1 and 3, the study group showed significantly lower serum creatinine kinase, IL-6, IL-10, and IL-1ra values than those in the control group. Additionally, IL-8 was significantly lower on day 7 after surgery. CONCLUSIONS: These data show that MI-THA decreased the release of muscle marker enzymes due to tissue damage immediately after surgery and minimized the inflammatory response related to the surgery during the early postoperative period.

Quantitative Analysis of Tissue Injury after Minimally Invasive Total Hip Arthroplasty

BACKGROUND: We intended to clarify the hypothesis that minimally invasive total hip arthroplasty (MI-THA) leads to less tissue damage and inflammatory response than does conventional total hip arthroplasty (C-THA). METHODS: We performed 30 cases of THA between September 2005 and May 2006 and evaluated these cases prospectively. We chose 15 MI-THA cases for the study group and another 15 C-THA cases for the control group. We checked skeletal muscle marker enzymes, such as serum creatinine kinase and aldolase, the pro-inflammatory cytokines, interleukin (IL)-6 and 8, and the anti-inflammatory cytokines, IL-10 and IL-1 receptor antagonist (ra) the day before surgery and at postoperative days 1, 7, and 14. RESULTS: On postoperative days 1 and 3, the study group showed significantly lower serum creatinine kinase, IL-6, IL-10, and IL-1ra values than those in the control group. Additionally, IL-8 was significantly lower on day 7 after surgery. CONCLUSIONS: These data show that MI-THA decreased the release of muscle marker enzymes due to tissue damage immediately after surgery and minimized the inflammatory response related to the surgery during the early postoperative period.

Cumulative effects of bone and soft tissue injury on systemic inflammation: a pilot study.

BACKGROUND: In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture. QUESTIONS/PURPOSES: We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both. METHODS: Male C57/BL6 mice (8-10 weeks old, 20-30 g) were assigned to four groups: bone fragment injection (BF, n = 9) group; soft tissue injury (STI, n = 9) group; BF + STI (n = 9) group, in which both insults were applied; and control group, in which neither insult was applied. Animals were sacrificed at 6 hours. As surrogates for systemic inflammation, we measured serum IL-6, IL-10, osteopontin, and alanine aminotransferase (ALT) and nuclear factor (NF)-κB and myeloperoxidase (MPO) in the lung. RESULTS: The systemic inflammatory response (mean IL-6 level) was similar in the BF (61.8 pg/mL) and STI (67.9 pg/mL) groups. The combination (BF + STI) of both traumatic insults induced an increase in mean levels of inflammatory parameters (IL-6: 189.1 pg/mL) but not in MPO levels (1.21 ng/mL) as compared with the BF (0.82 ng/mL) and STI (1.26 ng/mL) groups. The model produced little evidence of remote organ inflammation. CONCLUSIONS: Our findings suggest both bone and soft tissue injury are required to induce systemic changes. The absence of remote organ inflammation suggests further fracture-associated factors, such as hemorrhage and fat liberation, may be more critical for induction of remote organ damage. CLINICAL RELEVANCE: Both bone and soft tissue injuries contribute to the systemic inflammatory response.

Changes in serum fast and slow skeletal troponin I concentration following maximal eccentric contractions.

OBJECTIVES: We tested the hypothesis that fast skeletal muscle troponin I (fsTnI) concentration in serum would increase more than those of slow skeletal muscle troponin I (ssTnI) after eccentric exercise of the elbow flexors using a sensitive blood marker to track fibre specific muscle damage. DESIGN: Observational comparison of response in a single experimental group. METHODS: Eight young men (26.4±6.2 years) performed 210 (35 sets of 6) eccentric contractions of the elbow flexors on an isokinetic dynamometer with one arm. Changes in serum fsTnI and ssTnI concentrations, serum creatine kinase (CK) activity, and maximal voluntary isometric contraction torque (MVIC) before and 1, 2, 3, 4 and 14 days following exercise were analysed by a Student-Newman-Keuls multiple comparison test. The relationship between serum CK activity and fsTnI or ssTnI concentrations was determined using a Pearson's product moment correlation. RESULTS: Significant (P<0.05) decreases in MVIC and increases in serum CK activity and fsTnI were evident after exercise, but ssTnI did not change. The time course of changes in fsTnI was similar to that of CK, peaking at 4 days post-exercise, and the two were highly correlated (r=0.8). CONCLUSIONS: Increases in serum fsTnI concentrations reflect muscle damage, and it seems likely that only fast twitch fibres were damaged by eccentric contractions.

A pharmacokinetic study of a topical anesthetic (EMLA® ) in mouse soft tissue laceration.

The use of topical anesthesia instead of injection of local anesthetics for managing soft tissue lacerations in the emergency situations may be a relief for both patients and surgeons. Topical anesthesia in the form of a cream eutectic mixture of local anesthetics (EMLA®) containing 2.5% lidocaine and 2.5% prilocaine has been reported as an efficient anesthetic on skin before venipuncture anesthesia and as an alternative to injection anesthesia in some minor surgery situations. The aim of this study was to compare the pharmacokinetics of EMLA® when applied in a laceration with topical skin application in the mouse. A total of 120 Albino Laboratory-bred strain mouse (BALB-c) male mice were divided into three groups with regard to application mode of EMLA®. Group A: with laceration, 48 mice; Group B: on intact shaved skin, 48 mice; Group C: control group (24 mice) with same procedures but without application of EMLA®. Blood levels were collected at 0, 10, 20, 30, 45, 60, 75, and 90 min post-EMLA® application. Plasma sample analysis was carried out by employing liquid chromatography coupled with tandem mass spectrometric (LC-MS/MS) method, and the pharmacokinetic analysis of the mouse plasma samples was estimated by standard non-compartmental methods. The pharmacokinetic parameters of lidocaine and prilocaine were significantly altered following EMLA® application to lacerated mouse skin in contrast to intact skin. The absorption of lidocaine and prilocaine was rapid following application of EMLA® to lacerated and intact mouse skin. Maximum drug plasma concentration (C(max) ) and area under the drug plasma concentration-time curve (AUC) values of lidocaine were significantly increased by 448.6% and 161.5%, respectively, following application of EMLA to lacerated mouse skin in comparison with intact mouse skin. Similarly, prilocaine's C(max) and AUC values were also increased by 384% and 265.7%, respectively, following EMLA application to lacerated mouse skin, in contrast to intact skin. Further pharmacokinetic studies on different carriers of lidocaine/prilocaine are warranted before any firm conclusions for the clinic can be drawn.

Three cases using platelet-rich plasma to cure chronic soft tissue lesions.

PURPOSE: To report and discuss the three cases of patients with chronic non-healing wounds who underwent PRP therapy. METHODS: After thorough debridement and necessary dressing changes, 30-50 ml of whole blood was drawn from the patient's vein, from which PRP was extracted and applied to the wound. Seven or ten days later the wound was rechecked and other successive treatments were carried out if needed. RESULTS: All three patients achieved complete recovery and no recurrence reported (Pictures of the whole therapies were enclosed). CONCLUSION: PRP is a novel way to cure the chronic wounds, which can be used as a substitution when a wound goes non-healing and responds badly to the conventional treatments, such as dressing changing and some recombinant growth factors.

Bio-logic analysis of injury biomarker patterns in human serum samples.

Digital biosensor systems analyzing biomarkers characteristic of liver injury (LI), soft tissue injury (STI) and abdominal trauma (ABT) were developed and optimized for their performance in serum solutions spiked with injury biomarkers in order to mimic real medical samples. The systems produced 'Alert'-type optical output signals in the form of "YES-NO" separated by a threshold value. The new approach aims at the reliable detection of injury biomarkers for making autonomous decisions towards timely therapeutic interventions, particularly in conditions when a hospital treatment is not possible. The enzyme-catalyzed reactions performing Boolean AND/NAND logic operations in the presence of different combinations of the injury biomarkers allowed high-fidelity biosensing. Robustness of the systems was confirmed by their operation in serum solutions, representing the first example of chemically performed logic analysis of biological fluids and a step closer towards practical biomedical applications of enzyme-logic bioassays.

"Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study.

Symptomatic abnormal periprosthetic soft-tissue reactions ("pseudotumors") have been reported after metal-on-metal hip resurfacing arthroplasty (MoMHRA). The aims of this study were (1) to determine the prevalence of asymptomatic pseudotumors after MoMHRA and (2) to measure metal ion levels in these patients. A total of 201 hips in 158 patients were evaluated at a mean follow-up of 61 months (range, 36-88) using ultrasound/magnetic resonance imaging and serum/hip aspirate cobalt and chromium measurements. Pseudotumors found in 7 patients (4%) were associated with significantly higher cobalt and chromium levels and inferior functional scores. Elevated levels of cobalt and chromium ions suggest that pseudotumors are associated with increased wear generated from metal-on-metal articulations. Clinicians need to be aware of pseudotumors as a differential diagnosis during clinical evaluation of MoMHRA patients, and further imaging such as ultrasound or magnetic resonance imaging is recommended to confirm the diagnosis.

[Blood plasma zinc and copper concentrations in patients with purulent soft tissue wounds].

The paper considers postoperative imbalance of the trace elements zinc and copper in 40 surgical patients aged 47.2 +/- 17.1 years who have extensive purulent soft tissue wounds (PSTW). In 90% of the patients with PSTW, plasma Zn++ levels were much lower than the reference values (the normal value was 11.1-19.5 micromol/l) while in 47.5%, serum Zn++ was in the range of less than 7 micromol/l, which is a poor prognostic factor. There was a negative correlation between the level of Zn++ and that of C-reactive protein (CRP) and a positive correlation between the former and the magnitude of a reduction in transferrin (TF) as a marker of protein-energy malnutrition. Plasma Cu/Zn ratio is shown to be of very clinical importance. The higher this ratio (normal ratio 0.9-1.13) is, the more severe the general condition of patients with PSTW, the higher CRP values (above 120 mg/l; normal value 0-6 mg/l), and the lower TF levels are. In patients with PSTW, zinc level and Cu/Zn ratio may act as an independent predictor of a grave condition during a systemic inflammatory reaction.

Ebselen reduces inflammation and microvascular perfusion failure after blunt skeletal muscle injury of the rat.

BACKGROUND: Soft tissue trauma induces an local inflammatory response and yields a microvascular perfusion failure due to trauma-induced oxidative stress. Using high-resolution multifluorescence microscopy, we herein report on the efficiency of treatment with the oxygen radical scavenger ebselen to improve compromised perfusion of traumatized muscle tissue and to minimize secondary tissue damage. METHODS: By using a pneumatically driven computer-controlled impact device, closed soft tissue trauma of the left hind limb was induced in pentobarbital-anesthetized rats that received either ebselen (30 mg/kg body weight, intraperitoneally) or equal volumes of the vehicle dimethyl sulfoxide (DMSO). In an additional series of animals, ebselen or DMSO were applied without soft tissue trauma. RESULTS: Ebselen restored microcirculatory impairment within the injured muscle, as given by values of nutritive perfusion (763 +/- 44 cm/cm2), nicotinamide adenine dinucleotide levels (56 +/- 3 aU) and inflammatory cell interaction (leukocytes: 226 +/- 31 mm(-2)) at 24 hours after trauma, being not different to those found in noninjured muscle tissue of controls. In contrast, skeletal muscle in DMSO-treated animals revealed persistent perfusion failure (564 +/- 32 cm/cm2) with tissue hypoxia (nicotinamide adenine dinucleotide 75 +/- 11 aU) and enhanced endothelial interaction of leukocytes (383 +/- 18 mm(-2)) at 24 hours after trauma. CONCLUSIONS: Treatment of skeletal muscle soft tissue trauma with the glutathione peroxidase mimic ebselen is highly effective in restoration of disturbed microcirculation. Moreover, reduced inflammatory cell response helps to prevent leukocyte-dependent secondary tissue injury.

Serum complement-reactive protein (CRP) trends following local and free-tissue reconstructions for traumatic injuries or chronic wounds of the lower limb.

BACKGROUND: Soft-tissue reconstructions of the lower limb for open fractures, chronic infections and nonunion carry a high risk of infection, nonunion, osteomyelitis and amputation. Inflammatory markers can be difficult to interpret in the context of recent surgery and trauma and little is known of their behaviour. AIM: To profile the behaviour of complement-reactive protein (CRP) following soft-tissue reconstructions for the lower limb performed for acute injuries(open fractures) and chronic wounds(nonunion and osteomyelitis). PATIENTS AND METHODS: Patients who had soft-tissue reconstructions following open fractures of the lower limbs, chronic infection, osteomyelitis and nonunion were identified and their notes and postoperative CRP levels reviewed. RESULTS: 52 patients were identified. 41 reached peak CRP < or =4 days of surgery. A peak CRP >4 days indicated infection or further surgery (p<0.01). Acute and chronic groups showed a peak in mean CRP at day 2. Chronic wound patients showed significantly elevated CRP levels compared to acute wound patients at day 7 (p=0.05) and 8 (p<0.001). Muscle and fasciocutaneous flaps showed similar CRP profiles. Patients with nonunion or deep infections showed persistently elevated CRP levels. CONCLUSIONS: CRP peaks on day 2 following soft-tissue coverage and falls thereafter. Peaks after day 4 indicate infective complications or further surgery. Patients with chronic wounds show a slower decrease in their CRP. Persistently elevated CRP following surgery is associated with infection and nonunion.