Release of proteinase inhibitors as a vital reaction in the early post-traumatic interval

In a pilot study paraffin-embedded sections of open skin wounds (stab and slash wounds, lacerations) were investigated to determine the presence of a vital reaction. Granulocytes were detected by naphthol AS-D chloroacetate esterase, the enzyme "lysozyme", and eight proteinase inhibitors by the indirect immunoperoxidase method. The tissue specimens were taken from consecutive autopsy material. The survival time could be determined in 14 cases (10-165 min) and was unknown in 12 other cases of sudden death due to injury of the major vessels or heart. The controls were cases with injuries inflicted after and cases of sudden death due to massive blunt trauma served death. In vital injuries, accumulations of proteinase inhibitors, particularly alpha-2-macroglobulin and alpha-1-antichymotrypsin, were demonstrable in the corium parallel to the wound surface. In comparison, the reaction of proteinase inhibitors that neutralize only enzymes participating in blood coagulation or complement activation (C1-esterase inhibitor and protein C) was absent or weak. Protein accumulation was observed only sporadically in cases of sudden death and never in cases with wounds inflicted after death. No relationship could be established between semiquantitatively estimated staining and survival time. Granulocytes and lysozyme were first observed in the corium after a survival time of more than 60 min.