Electron Microscopic and Histochemical Observations of Muscle Degeneration After Tourniquet

Abstract

Muscle degeneration and a shock syndrome, which frequently results in death, follow the release of limb tourniquets. Albumin and other plasma components are transferred into the affected muscle tissue (1-4) while toxic products of autolysis and hemolytic substances appear in the circulating blood (5-7). It is possible that this abnormal transfer results in part from damage of capillaries and muscle fiber membranes. The application of cold delays autolysis and fluid exchange, modifies the shock symptoms, and reduces mortality (8). Chemical changes, such as the large decrease in phosphorus (9) and morphologic alterations, as revealed with the light microscope (9, 10), have been carefully studied. Wide interfibrillar spaces are observed in tissues taken immediately after release of the tourniquet, and some fibers show discoid decay of their fibrils. The primary alterations are followed several hours later by advancing granular and hyaline degeneration.The present communication extends the light microscopic observations of the succinic dehydrogenase distribution in normal fibers (11) to the degenerated fibers. With the electron microscope an attempt is made to visualize the finer details in the development of discoid, hyaline, and granular degeneration seen after release of the tourniquet. The alterations thus produced are common to an extremely wide variety of muscle lesions. Further experience will determine whether degenerations of different etiology, such as those caused by bacterial toxins, vitamin E deficiency, or Coxsackie virus infection will expose specific details characteristic of each lesion. MethodsAs in antecedent electrophoretic studies of blood and tissue extracts after shock-producing injuries (2-4), the technique of Rosenthal (12) was used for traumatizafion of hind legs of C57

Ultrastructural Changes in Striated Muscle after Experimental Tourniquet Ischaemia and Short Reflow

“…Correlation between the degree of myofibrillar alterations and dura tion of ischaemia vary in the reports. Discoid degeneration and disorgani zation of the Z bands has been reported after only 2 h ischaemia in some cases [12,15]. Degeneration of motor end-plates and intramuscular nerves has been suggested to occur after 3 h ischaemia [16].…”

“…This may, in part, be due to dif ferent techniques of producing the ischaemia, such as ligation of the distal aorta [12], ligation of common iliac and common femoral arteries [7,9] or selective ligation of blood supply to the peripheral muscles [21]. In ad dition, different kinds of tourniquets have been applied [2,8,15,16]. Differences in results in the previous literature are probably also due to the fact that ischaemia has not been complete, especially in studies where the various ligation techniques were used.…”

“…In most instances the tourniquet blockade is limited to 2h [6,17,27], However, in time-consuming reconstructive operations this limit of 2 h is sometimes exceeded. It has been reported that the magnitude of deleter ious effects on the striated muscle correlates with the extent of ischaemia [2,12,15,22,23]. In histological studies structural alterations in striated muscle have been reported after Vs-2 h ischaemia [2, 9.…”

An Electron Microscopic Study of Myocardial Ischemia in the Rat

“…Barrnett and Palade have reported the ultrastruetural changes occurring with autolysis of rat myocardium. 10 Moore, Ruska and Copenhaver 11 described the degenerative process in leg muscles distal to a tourniquet.…”

Electron Microscopy of Post‐Mortem Changes in Porcine Muscle

“…Most electron microscope work has been designed to obtain samples in the highest state of preservation possible. However, Moore et al (1956) studied degeneration in muscle following tourniquet, and noticed some dissolution of the I bands and also of the Z lines.…”