[Significance of the factors in wound healing for the origin of chronic subdural hematoma--fibronectin and its related substances]

Abstract

The role of substances for wound healing in chronic subdural hematoma was investigated. Fibronectin, blood coagulation factor XIII (F X III), alpha 2 -plasmin inhibitor (alpha 2-PI) and alpha 2-PI plasmin complex (PIC) in hematoma fluid were measured, sixty cases of hematoma fluid (15 cases were bilateral chronic subdural hematomas) were used for analysis. The levels of fibronectin in hematoma fluid ranged widely from 40 to 1068 micrograms/ml. The levels of F XIII (except 1 case) in the hematoma fluid were less than 70% (normal plasma level 72-144%). And also the levels of alpha 2-PI in the hematoma fluid were lower than that in normal blood plasma (85-115%). Fibrin, fibronectin, alpha 2-PI and collagen crosslinks to these proteins by the catalytic action of the activated F XIII. These substrate proteins (except fibronectin) and F XIII were extremely low levels for wound healing. Histological analysis of the membrane with dura mater obtained from 13 patients was performed by Abidin-Biotin peroxidase Complex Method. Fibronectin was identified in outer membrane especially in sinusoidal layer. In normal wound healing, fibronectin appears early with the invading fibroblast and disappeares within 5 weeks from injury. But in chronic subdural hematoma it was not disappeares in 8 weeks after the head injury. The fact indicates the neomembrane of the chronic subdural hematoma is not in healing stage. This condition in chronic subdural hematoma is unfavorable for wound healing. Thus, author suspected that in early phase of wound healing after the head injury fibronectin and its related substances may play a role in the formation of chronic subdural hematoma.