Citation

Spear AM, Davies EM, Taylor C, Whiting R, Macildowie S, Kirkman E, Midwinter M, Watts SA. Shock 2015; 44(5): 470-478.

Affiliation

*Biomedical Sciences Department, Defence Science and Technology Laboratory, Porton Down, Wiltshire †Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham.

Copyright

(Copyright © 2015, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0000000000000455

PMID

26418548

Abstract

Extremity injury is a significant burden to those injured in explosive incidents and local ischaemia can result in poor functionality in salvaged limbs. This study examined whether blast injury to a limb resulted in a change in endothelial phenotype leading to changes to the surrounding tissue.The hind limbs of terminally anaesthetised rabbits were subjected to one of four blast exposures (high, medium, low or no blast). Blood samples were analysed for circulating endothelial cells pre-injury and at 1, 6 and 11 hours post-injury as well as analysis for endothelial activation pre-injury and at 1, 6 and 12 hours post-injury. Post-mortem tissue (12 hours post-injury) was analysed for both protein and mRNA expression and also for histopathology.The high blast group had significantly elevated levels of circulating endothelial cells (CECs) 6 hours post injury. This group also had significantly elevated tissue mRNA expression of IL-6, E-selectin, TNF-α, HIF-1, thrombomodulin and PDGF. There was a significant correlation between blast dose and the degree of tissue pathology (haemorrhage, neutrophil infiltrate and oedema) with the worst scores in the high blast group.This study has demonstrated that blast injury can activate the endothelium and in some cases cause damage which in turn leads to pathological changes in the surrounding tissue. For the casualty injured by an explosion the damaging effects of haemorrhage and shock could be exacerbated by blast injury and vice versa so that even low levels of blast become damaging, all of which could impact on tissue functionality and long-term outcomes.© Crown copyright (2015), Dstl. This material is licensed uner the terms of the Open Government Licence except where otherwise stated. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-governnment-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London, TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk.

Language: en