Early local and systemic fibrinolytic response to high energy missile trauma

In dogs, tissue and blood fibrinolysis was studied after a high velocity missile injury to one hind leg. Plasminogen activator activity in skeletal muscle at different distances from the wound was estimated with a histochemical method. Samples from venous blood draining both the injured and the not injured leg were regularly analysed for fibrinogen, plasminogen, alpha 2-antiplasmin, alpha 2-macroglobulin, fibrinolysis on fibrin plates and fibrin(ogen) degradation products. Tissue close to the bullet track judged as devitalized displayed a significant and persistent reduction of plasminogen activator activity. The same pattern of reaction was observed in muscle without apparent lesions 3 cm from the wound but no uniform pattern could be discerned at a distance of 10 cm. In the blood a very early activation of fibrinolysis took place. There was no difference between the two sides, thus the trauma induced a general activation of fibrinolysis in the organism. Towards the end of the experiments a continuous decrease of fibrinolysis in the euglobulin fraction of plasma on fibrin plates was noted. Concomitantly an increase of plasmin inhibitors took place. It was concluded that a high velocity missile injury to skeletal muscle induced a reduction of plasminogen activator activity in the tissue surrounding the wound. A very early and general activation of systemic fibrinolysis was followed by a decreased fibrinolysis within a few hours.