Preinjury Level Of Function Research Articles

Surgical treatment of chronic acromioclavicular joint dislocation using the Weaver–Dunn procedure augmented by the TightRope® system

Variable outcomes resulting from the availability of multiple techniques for the treatment of chronic acromioclavicular joint (ACJ) dislocation have led to difficulty in choosing the optimal therapeutic strategy. Accordingly, the authors describe a technique for the treatment of chronic ACJ dislocation and its benefits. The authors present a technique for surgically treating chronic ACJ dislocation using the Weaver-Dunn procedure in combination with a commercially available system (TightRope; Arthrex, Naples, FL, USA). Nine patients with chronic ACJ dislocation were surgically treated and postoperative results were evaluated. The patients were followed up for a mean of 20 months. Shoulder function was evaluated using the Constant score, with a mean score of 97%. Compared with the uninjured side, radiography showed anatomical repositioning in the vertical plane in seven cases and slight loss of reduction in two cases. The procedure provided good functional and subjective results. All patients returned to their pre-injury activity levels. The Weaver-Dunn procedure augmented by the TightRope system appeared to be an effective for treating chronic ACJ dislocation and led to excellent outcomes in terms of return to pre-injury level of function.

The Treatment of Intertrochanteric Fractures of the Femur with Endovis Nail

BACKGROUND The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nowadays, there is an increasing interest in intramedullary nailing, especially for unstable intertrochanteric fractures. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with the Endovis® proximal femoral nail in the treatment of peritrochanteric fractures to solve the problems associated with the use of intramedullary fixation devices. MATERIAL AND METHODS The authors describe their experience with 87 stable and unstable proximal extra-capsular femoral fractures treated with the Endovis femoral nail from July 2007 to March 2009. The results were evaluated clinically, functionally and radiographically during the 1st, 3th, 6th and 12th months post-op. Pre-injury activity and functional levels were recorded using the modified Harris hip score and V.A.S. score. RESULTS Postoperative radiographs showed a near-anatomical fracture reduction in 85% of patients. Three were the cases of cut-out, one case of valgus and two cases of shortening of the operated leg (<1 cm). The Harris Hip Score increased between the thirtieth and ninetieth postoperative day, accompanied by a significant decrease in pain symptoms and functional limitation. CONCLUSION 1. The application of an intramedullary nail provides primary stability of the fracture. 2. The Endovis nail constitutes a powerful synthesis for stable and unstable fractures of the trochanteric region, in which is difficult to reconstruct appropriate continuity between the medial and posterior cortical layers. 3.The good mechanical stability of the nail allows rapid mobilization and early functional recovery. 4. The presence of an additional anti-rotational screw and the free sliding mechanism of the lag screw may increase rotational stability of cervico-cephalic fragments and decrease overload on the femoral head.

Lateral ankle instability in high-demand athletes: reconstruction with fibular periosteal flap

Fibular periosteal flaps have been used to address chronic lateral ankle instability, but there are no studies in the literature reporting functional outcomes after this particular procedure in high-demand athletes. We postulated that for chronic instability, nonanatomical reconstruction of the lateral ankle ligament with a fibular periosteal flap will return high-demand athletes to their previous levels of activity. Forty patients who had grade III ankle sprain and experienced no success after a course of supervised conservative management lasting at least six months and who had a preinjury Tegner score of ≥ 6 underwent a lateral compartment reconstruction with a fibular periosteal flap. Each patient was given the Tegner and Karlsson questionnaire and was evaluated by the Zwipp method, Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score at the six-month, one, two and three-year time points. Range of motion (ROM) of the affected ankle was assessed, and stress X-rays were performed. Mean patient age was 24.5 (range17-30) years, and no patient was lost to follow-up. Mean follow-up was 36 (minimum 18) months, mean Tegner scores at the one, two and three-year time points were 8.8, 8.9 and 8.9, respectively, and mean Karlsson scores were 93 ± 5.2, 95 ± 3.1 and 94.9, respectively. AOFAS and FAOS scores improved from a mean of 69.4 and 71.4, respectively, in the preoperative group to a mean of 97.2 and 94.4, respectively, at the last follow-up. The ROM was equal to the contralateral ankle in all but two patients at the two-year follow-up. No major complications were found. Nonanatomical ligament reconstruction with a fibular periosteal flap for chronic lateral ankle instability was effective in returning high-demand athletes to their preinjury functional levels.

Chronic Symptomatic Os Subfibulare in Children

Some children have persistent pain and instability following inversion injuries of the ankle. Radiographs may reveal a small osseous fragment distal to the lateral malleolus, suggesting an avulsion injury of the anterior talofibular ligament and/or calcaneofibular ligament. The avulsion injury may involve an os subfibulare, causing ligamentous laxity and chronic pain resulting from nonunion. This situation must be differentiated from an asymptomatic os subfibulare, which is a normal anatomic variant in 1% of children. The purpose of this study was to evaluate the intraoperative findings and long-term outcomes of patients treated operatively for symptomatic avulsion injuries or a symptomatic os subfibulare. Twenty-three patients presented with chronic ankle pain and instability, tenderness anterior and distal to the lateral malleolus, and imaging studies (magnetic resonance imaging and/or stress radiographs) suspicious for avulsion injury of the anterior talofibular ligament and/or calcaneofibular ligament. After unsuccessful nonoperative treatment, all patients underwent excision of the osseous fragments, anatomic reconstruction of the anterior talofibular ligament with use of drill holes through the lateral malleolus, and a modified Broström procedure. The mean age of the patients was 10.4 years (range, eight to thirteen years) at the time of injury and 13.6 years (range, eight to seventeen years) at the time of surgery, representing a mean delay in diagnosis and treatment of 3.2 years. At a mean follow-up of 4.5 years (range, 2.1 to 13.2 years), the mean Foot and Ankle Outcome Score was 91.4 (range, 87 to 98) out of 100, with all but one patient returning to the preinjury recreational level. Only one patient had a long-term complication. In children with chronic pain and instability associated with an os subfibulare, surgical excision of the os subfibulare combined with reconstruction of the anterior talofibular ligament and a modified Broström procedure was effective in restoring ankle stability, eliminating pain, and permitting return to the preinjury functional level.

Management pitfalls of fractured neck of femur in osteogenesis imperfecta

Fractured neck of femur in osteogenesis imperfecta is rarely reported. Its management is always difficult because of bone fragility and the outcome is not well known. We, therefore, aimed to study the management pitfalls in this group of patients. We retrospectively reviewed five cases of fractured neck of femur in four patients treated in our hospital between 2006 and 2009. The demographic data, mode of injury, fracture configuration, treatment, complications, clinical and radiological outcome were reviewed. According to the Sillence classification, one patient was type I, two were type III and one was type IV. There were two children (aged 8 and 15 years) and two adults (aged 21 and 22 years), with the 8year-old girl suffering from hip fracture on different sides in two accidents. All five hip fractures were the result of low-energy injury and were associated with other fractures. Two undisplaced fractures required intra-operative fluoroscopic confirmation to demonstrate movement at the fracture site. The interval between the injury and fixation ranged from 6h to 3days. One hip required secondary surgery to openly reduce the fracture due to inadequate primary fixation and reduction. Two hips were fixed with paediatric dynamic hip screws and three hips were fixed with cannulated screws. All patients were immobilised in hip spica for 6weeks. The average follow-up was 4years (3-5years). All patients had satisfactory union and none of them developed radiological evidence of avascular necrosis at the latest follow-up. All patients returned to their pre-injury functional level. Fractured neck of femur is rare given the high prevalence of long bone fractures in osteogenesis imperfecta. They all have characteristic associated fractures of the extremity at the time of injury and neck of femur fractures could be easily missed. Fracture fixation is a great challenge to the orthopaedic surgeons because of the small size of the patients, poor bone quality with suboptimal imaging intra-operatively and compromised purchase of fixation devices. The choice of implants should be determined by the size of the patients and the presence of prior instrumentation close to the hip joint.

THU0378 Predictors of One-Year Mortality in Elderly Hip Fracture Patients

BackgroundThere is growing evidence that devastating consequences of hip fracture can possibly be counteracted with multidisciplinary inpatient rehabilitation3. Recognition of variables that influence mortality at an early stage is needed...

Recovery from traumatic injury: Trauma patients’ perceptions of facilitators and barriers

BackgroundIndividuals who have sustained an unintentional physical traumatic injury often undergo a lengthy and arduous process of recovery, as they strive to return to pre-injury levels of physical, occupational and social function. However, little research has been conducted on interventions to support trauma patients during recovery, and the few interventions implemented have limited success. ObjectivesThis qualitative descriptive study was designed to explore the facilitators and barriers to the recovery process to inform nursing interventions and research. MethodsA sample of 13 individuals in the southeast United States, who sustained an unintentional traumatic injury requiring hospitalization in the previous 6months, completed an in-person semi-structured interview. Data were analyzed using line by line coding, identification of patterns and themes, and constant comparison of themes to the data. ResultsFour major themes that facilitated recovery from injury were identified: support, coping, processing, and progress. Major barriers to recovery included financial losses, physical changes, lack of information, and emotional consequences. DiscussionTrauma patients need informational and support resources, especially peer support from those with a similar injury, to provide indicators of progress and promote successful integration of the injury event and its consequences into their views of self.

Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.

A review of anterior cruciate ligament injuries and reconstructive techniques. Part 1: Basic science

Anterior cruciate ligament rupture is a common soft tissue knee injury, often affecting young athletic individuals keen to return to pre-injury levels of function. Increasing sporting activity is reflected by an increasing incidence of anterior cruciate ligament rupture. Although treatment has advanced considerably over the years, there are still a number of contentious issues that are considered in this review. The anterior cruciate ligament is a dense band of connective tissue, comprising an anteromedial and posterolateral bundle based on tibial insertion sites. It is important to appreciate the position and orientation of these bundles at the time of reconstructive surgery. The bundles, with their load sharing behaviour through knee flexion, affect antero-posterior and rotational stability of the knee. In the first part of this review, we consider the clinical presentation of anterior cruciate ligament injury and relevant anatomy, knee kinematics, mechanism of injury and incidence of anterior cruciate ligament ruptures.

Reconstructive and prosthetic options for the wounded warrior

A recent estimate of wounded from the Afghanistan war is close to 17,000 and from the Iraq war over 30,000. Extremity trauma is the one of the hallmark injuries from these conflicts. The long-term effects of this number of extremity-injured patients on our military and civilian health care systems is unknown. The relative severity, if amputation rate can be used as a surrogate, is significantly higher than in civilian trauma. In this article, we discuss the most current management strategies used in these complex patients and the myriad of lower extremity disease they experience. We also discuss a new “standard” for patients with severe lower extremity trauma. Previous expectations were to return patients to their preinjury level of function with limb retention. Now, the new expectation of this group of patients is to recover in a time frame and function level equivalent to a below knee amputee, which is a more accelerated course. Several advances have been made in an effort to offer similar functional results to these severely injured patients to include the gradual expansion muscle (GEM) flap, which corrects soft-tissue defects as well skeletal defects without the use of free-tissue transfer. Another significant advance is the Intrepid Dynamic Exoskeleton Orthosis (IDEO), which is a plantarflexion powered carbon fiber ankle-foot orthosis that allows patients with limb salvage the opportunity to return to high-impact activities. Other germane topics reviewed include management of calcaneal fractures with severe soft-tissue injury, partial foot amputations, and elective amputations for the indication of pain.

Minimally Invasive Percutaneous Plate Fixation of Tibia Fractures: Results in 80 Patients

Minimally invasive percutaneous plate fixation (MIPPF) has gained wide acceptance for treating periarticular fractures of the tibia. Despite the theoretical biological advantages of MIPPF, it is unclear whether these are offset by wound complications, union rate, and malalignment. We therefore estimated the rate of union in tibial fractures treated by MIPPF, the rate of major and minor wound complications, occurrence of malunion, and level of function. We retrospectively reviewed 80 patients with tibia fractures treated by MIPPF. Mean age of patients was 43 years (range, 18-74 years); there were 54 male and 26 female patients. Severe soft tissue injuries were seen in 16 patients. Patients were examined clinically for soft tissue condition, ROM, alignment, and determination of function (Lower Extremity Functional Score). Radiographs and CT were obtained to determine union and malunion. The minimum followup was 12 months (mean, 23 months; range, 12-48 months). Sixty-three patients (79%) had uneventful healing of the fractures. We identified minor wound complications in seven patients (9%). Delayed union occurred in three (4%) and nonunion in seven (9%); noticeable axial malalignment occurred in five (6%), whereas rotational deformities greater than 10° were revealed with the use of CT in 25% of cases. MIPPF allowed uneventful healing and restoration of the preinjury level of function in most patients. However, complications occurred in a substantial number of patients, which needs attention when planning surgery.

Femoroacetabular Impingement

Both arthroscopic and open operative treatment of femoroacetabular impingement (FAI) can reproducibly relieve hip pain with correction of the underlying osseous deformity and treatment of the associated labral pathology, particularly in patients without substantial articular cartilage injury at the time of surgery. Between 75% and 90% of athletes undergoing FAI surgery return to sports at their pre-injury level of function. There is no peer-reviewed evidence to date reporting on the efficacy of nonoperative treatment and return to play with FAI. Successful operative treatment of impingement requires appropriate and complete correction of the mechanical injury that led to the symptomatic labral pathology. Early intervention prior to the onset of irreversible chondral damage is critical to the long-term success of FAI surgery. Complex deformities involving combinations of static and dynamic mechanical factors often coexist, so careful preoperative evaluation of the underlying structural anatomy is critical to successful treatment planning.

Neuroinflammation and the dynamic lesion in traumatic brain injury

Until the latter half of the 20th century, moderate to severe traumatic brain injury (TBI) was rarely a survivable event (Masel and DeWitt, 2010). Fortunately, improvements in neuroimaging, and emergency medical and neurosurgical care have dramatically increased survival along with improved understanding and characterization of the acute effects of TBI. With improved survival, it was also assumed that understanding the acute effects of TBI would lead to strategies for better outcome, helpful in rehabilitation and more predictive of recovery or disability. During this era, standardizations emerged to categorize acute TBI by severity, most commonly based on the Glasgow Coma Scale, whether loss of consciousness occurred, duration of post-traumatic amnesia, presence/absence of skull fracture and neuroimaging findings. Because TBI has an obvious aetiology and onset, classic and well-defined neuropathologies from initial injury through chronic phases have been well characterized, including the macroscopic pathologies identified using neuroimaging. In fact, considerable optimism emerged that, as neuroimaging methods improved, detection of TBI-related pathologies such as cerebral oedema, contusions, intraparenchymal haemorrhages, epidural and subdural haematomas, that better predicted long-term outcome would occur. However, modelling long-term TBI outcome, in particular cognitive outcome, has proved elusive, even taking into account all of the acute TBI variables. Understanding outcome amounts to more than the severity of injury or even the size, type and location of traumatic lesions. What may be missing in TBI outcome models reveals an incomplete understanding of how these lesions influence neural networks of the functioning brain (Caeyenberghs et al., 2012). In other words, how well a patient with TBI returns to pre-injury level of function may depend most on how well functional neural networks survive and/or adapt to the injury. Networks depend on white matter integrity and therefore understanding white matter pathology is crucial in understanding TBI outcome. As elegantly described many years ago, white …

Nail Hooks and Elastic Bands External Dynamic Traction for Fractures of the Proximal Interphalangeal Joint

Intra-articular fractures of the proximal interphalangeal joint remain a treatment challenge for hand specialists. The purpose of this investigation was to review the results of 12 patients, 6 men and 6 women (average age, 21 y), who were treated using the nail hooks and elastic bands external dynamic traction technique for their intra-articular proximal interphalangeal joint fractures. Of the total 12 fractures, 6 involved the proximal phalanx and 6 involved the middle phalanx. The final arc of motion at the proximal interphalangeal joint averaged 89 degrees (range, 25 to 111 degrees). At the conclusion of treatment: 1 patient developed a radial deviation and 1 developed a slight ulnar deviation. All patients were able to return to their preinjury level of functioning. Nail hooks and elastic bands external dynamic traction provides an effective treatment for intra-articular proximal interphalangeal joint fractures. It is an inexpensive, easily applied, nonoperative method of treatment.

Return to pre-injury health status and function 12 months after hospitalisation for sport and active recreation related orthopaedic injury

BackgroundHospitalised sport and active recreation injuries can have serious long-term consequences. Despite this, few studies have examined the long-term outcomes of these injuries. The purpose of this study was to...

Disruptions of the Pelvic Ring: An Update: Editorial Comment

For more than three decades, since the publication of the first pelvic symposium in Clinical Orthopaedics and Related Research in 1980, much progress has been made in the evaluation and treatment of disruptions of the pelvic ring. Despite this progress, many questions remain unanswered and new ones have been raised. This symposium attempts to address a number of these unresolved issues. Its content should be of interest and value to all those involved in the management of patients sustaining an injury to the pelvic ring. An injury to the pelvic ring often results from a high-energy traumatic event, such as a motor vehicle accident. Therefore, these high-energy pelvic ring disruptions are frequently accompanied by additional musculoskeletal or other system injuries. With the advent of Advanced Trauma Life Support protocols and the stratification of medical centers based on their ability to evaluate and treat those who sustain high-energy trauma, patient survival has dramatically improved. However, patients continue to die from these injuries. What are the risk factors that predispose the demise of these patients and how can we better train surgeons to be competent in managing severely injured patients? After the patient has been evaluated and initially stabilized, the appropriate definitive management must be determined. Due to the importance of this topic and the recent introduction of alternative methods, a major portion of the symposium is devoted to definitive pelvic ring fixation. Is the anterior internal fixator a reasonable—or better—alternative to standard anterior fixation techniques? What happens when symphyseal plates fail? And does overconcern and misperception concerning the risk of infection cloud our decision-making process, favoring the use of closed techniques when open reduction might prove superior? These are some of the timely, focused topics of the papers in the middle section of this symposium. Fig. 1 Dr. Berton R. Moed is shown. This symposium includes new information regarding perhaps the most important aspect of pelvic ring injury care, namely the eventual function of the patient. No different from the care of any patient with an injury to the musculoskeletal system, the ultimate goal is to return patients with pelvic ring injuries to their preinjury level of function. Over the years, the pendulum of conventional wisdom has swung wildly between “they all do well” to “they all do poorly” and all points in between. It is of the utmost importance to avoid the dogma and focus on what is actually going on with our individual patients, thereby providing appropriate care and realistic expectations. Fig. 2 Dr. Mark S. Vrahas is shown. We would like to thank all of the authors for contributing their excellent work to this symposium. The topics are timely and add important information to the continually growing body of knowledge in the field of pelvic ring injury care. We would also like to thank all the reviewers who assisted us in the evaluation and vetting process. It is our sincere belief and expectation that the material presented will both inform and stimulate those involved in the care of the patient with a disruption of the pelvic ring.

The treatment of intertrochanteric fractures of the femur with Endovis nail

The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nowadays, there is an increasing interest in intramedullary nailing, especially for unstable intertrochanteric fractures. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with the Endovis® proximal femoral nail in the treatment of peritrochanteric fractures to solve the problems associated with the use of intramedullary fixation devices. The authors describe their experience with 87 stable and unstable proximal extra-capsular femoral fractures treated with the Endovis femoral nail from July 2007 to March 2009. The results were evaluated clinically, functionally and radiographically during the 1st, 3th, 6th and 12th months post-op. Pre-injury activity and functional levels were recorded using the modified Harris hip score and V.A.S. score. Postoperative radiographs showed a near-anatomical fracture reduction in 85% of patients. Three were the cases of cut-out, one case of valgus and two cases of shortening of the operated leg (<1 cm). The Harris Hip Score increased between the thirtieth and ninetieth postoperative day, accompanied by a significant decrease in pain symptoms and functional limitation. 1. The application of an intramedullary nail provides primary stability of the fracture. 2. The Endovis nail constitutes a powerful synthesis for stable and unstable fractures of the trochanteric region, in which is difficult to reconstruct appropriate continuity between the medial and posterior cortical layers. 3.The good mechanical stability of the nail allows rapid mobilization and early functional recovery. 4. The presence of an additional anti-rotational screw and the free sliding mechanism of the lag screw may increase rotational stability of cervico-cephalic fragments and decrease overload on the femoral head.

Individualized Plan of Care for the Geriatric Patient With Acetabular Fracture

Elderly adults currently represent the most rapidly growing segment of the patient population. As the number of geriatric patients increases, the incidence of acetabular fractures in this population can be expected to increase as well. Optimal management of these injuries is controversial. Patient factors, such as preinjury functional level, medical comorbidities, and poor bone quality, can confound the treatment plan, as can injury characteristics, such as fracture pattern and articular damage. Although open reduction and internal fixation has been advocated as the gold standard for any displaced acetabular fracture, in the elderly patient alternatives, including percutaneous fixation and total hip arthroplasty, either acute or delayed, should be considered. Exact indications for each of these options are often unclear. Although it is helpful to follow a logical algorithm in determining the best management for the geriatric acetabular fracture, the importance of individualizing treatment cannot be overemphasized.

Muscle co-contraction after anterior cruciate ligament reconstruction: Influence of functional level

Background ACL reconstruction is recommended to improve function in subjects with ligament injuries. However, after surgery, some individuals are not able to return to their pre-injury functional level. The mechanisms related to this incapacity are not well understood. Study design Cross-sectional study. Methods Co-contraction levels were assessed in individuals who returned to their pre-injury functional level and in 10 individuals who were not able to return to full activity after unilateral ACL reconstruction. Electromyography of the vastus lateralis and biceps femoris muscles before and after sudden perturbations applied during the stance phase of walking was used to calculate co-contraction. Results The involved limb had lower co-contraction pre-perturbation than the non-involved limb in both groups ( p = 0.049). The co-contraction level post-perturbation was significantly higher in the limited return group than in the full return group ( p = 0.03). Conclusion Decreased co-contraction in the involved limb before perturbation may be caused by sensorial changes resulting from surgery or injury. Increased co-contraction levels observed in the limited return group after perturbation may be a compensatory mechanism to make up for possible decreased intrinsic stability of the knee joint. Clinical relevance Increased co-contraction after perturbation does not contribute to knee stability.

Temporal changes in microvessel leakiness during wound healing discriminated by in vivo fluorescence recovery after photobleaching

Regeneration of injured tissue is a dynamic process, critically dependent on the formation of new blood vessels and restructuring of the nascent plexus. Endothelial barrier function, a functional correlate of vascular restructuring and maturation, was quantified via intravital microscopic analysis of 150 kDa FITC-dextran-perfused blood vessels within discrete wounds created in the panniculus carnosus (PC) muscle of dorsal skinfold chamber (DSC) preparations in mice. Time to recovery of half-peak fluorescence intensity (t(1/2)) within individual vessel segments in three functional regions of the wound (pre-existing vessels, angiogenic plexus and blind-ended vessels (BEVs)) was quantified using in vivo fluorescence recovery after photobleaching (FRAP) and linear regression analysis of recovery profiles. Plasma flux across the walls of new vessel segments, particularly BEVs, was greater than that of pre-existing vessels at days 5-7 after injury (P < 0.05). TNP-470 reduced the permeability of BEVs at the leading edge of the advancing vascular plexus as measured by the decrease in luminal t(1/2) (P < 0.05), confirming the utility of FRAP as a quantitative measure of endothelial barrier function. Furthermore, these data are suggestive of a role for TNP-470 in selection for less leaky vascular segments within healing wounds. Increased FITC-dextran leakage was observed from pre-existing vessels after treatment with TNP-470 (P < 0.05), consistent with induction of transient vascular damage, although the significance of this finding is unclear. Using in vivo FRAP this study demonstrates the relationship between temporal changes in microvascular macromolecular flux and the morphology of maturing vascular segments. This combination of techniques may be useful to assess the therapeutic potential of angiogenic agents in restoring pre-injury levels of endothelial barrier function, following the establishment of a functional vascular plexus such as in models of wounding or tumour development.