The pathogenesis of the ischemic myositis is still controversial although most agree that arterial obstruction or it´s reflex spasm is the main cause in the development of the ischemic contracture of the muscle. Concomitant venous occlusion and neural interruption must play an important role in the development of the ischemic myositis.
In the meanwhile, failure in the early diagnosis and treatment of degeneration, be it due to occlusion of a major peripheral vesseles or to a compartmental compression and to interruption of a major nerves of a limb, may lead to a serious and irreversible change of the muscle.
The purpose of this study is to evaluate and compare the degenerative or necrotic changes in skeletal muscles employing HBFP (hematoxylin basic fuchsin picric acid) stain following muscle ischemia or neural interruption and their restorations, either qualitatively and quantitatively.
The author has undertaken an experimental study upon morphological changes of the muscle after ligation´ of vessels and cutting of nerve of the rabbit limb, and attempted to detect sequential changes in the affected muscle by histochemical staining method developed originally by Lie et al., that is, hematoxylin basic fuchsin picric acid (HBFP) staining method.
One hundred and two rabbits weighinghing 2, 000^2, 500gm were divided into the three goups.
In the group 1 which has 51 rabbits, the degenerative or necrotic changes were studied after the ligations of a) both femoral artery and vein b) the femoral artery and c) the femoral vein. Muscle biopsy was carried out of the tibialis anterior muscle after 5, 10 and ,30 minutes, and 1, 2, 3, 4, 5, 6, 8,10,12,15,18, 21, 24 and 48 hours using one rabbit each time.
In the group 2 which was 30 rabbits, the degenerative and necrotic or regenerative changes were studied after the release of the ligation of the femoral vessels a) when the degeneration
were noted in the whole fibe s and b) when the necrosis were noted in the half of whole fibers which are detected by the results of HBFP stain in the group 1. Muscle biopsy was carried out of the tibialis anterior muscle after 1, 2, 3, 5, 7 and 9 days using one rabbit each time.
In the group 3 which was 21 rabbits, the degenerative of necrotic changes were studied after the cutting of the sciatic nerve. And then, muscle biopsy was carried out of the same muscle with same intervals as for the group 1 and 2, that is from 5 minutes to 9, days, using one rabbit each time.
The biopsied samples were fixed in formalin and stained with H & E and HBFP stain for microscopic evaluation of muscle changes.
The results obtained are as follows:
1. After the ligations of the femoral vessels performed in the group 1, the earliest evidences of muscular degeneration were detected by HBFP staining method within 10 minutes. This is the case of the of the simultaneous ligation of the femoral artery and vein which is 32% of the total fibers. This is the case of the femoral artery ligation which is 28% of the whole. This is the case of ligation of the femoral vein which is 12% of the total. However, it was required more than 4 hours, 4 hours and 6 hours respectively to detect such changes by H&E staining method.
2. In the group 1, the degenerative or necrotic changes have progressed with time. In case of the sinultaneous ligation of the femoral artery and vein the changes were most remarkable. In the case of the ligation of the femoral artery the changes were moderate. In the case of the ligation of the fenoral vein the changes were the smallest in a certain time.
3. In the group 1, the degenerative changes were detected by HBFP staining method in the whole fibers without evidences of the necrosis after 6 hours in the case of the simultaneous ligation of the femoral artery and vein; after 8 hours in the femoral artery ligation; after 18hours in the femoral vein ligation. However, it was required 15 hours, 18 hours, and 48 hours respectively to detect such changes by H&E staining method without evidence of the necrosis.
4. In the group 1, the necrotic changes progressed in the half of the entire fibers in the case of the simultaneous ligation of the femoral artery and vein after 12 hours by HBFP staining method; in the case of the femoral artery ligation after 18 ohurs; in the case of the femoral vein ligation after 48 hours.
5. After the release of the femoral ligation after certain period of time given by the HBFP findings of the group 1, in the group 2, the necrotic changes became worse about 5% to 15% in the first or second days, and the changes were stabilized relatively up to the nineth day after its release by HBFP staining method.
6. After cutting the sciatic nerve in the group 3, the degenerative changes were detected within one hour by HBFP staining method, whereas it requires 9 days by H&E staining method to detect such changes. And as a whole, the degenerative changes progressed more slowly than in the group 1 and 2 in the course of time.
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