Review: Acute Compartment Syndrome of the Foot

2003 ◽  
Vol 24 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Eric Fulkerson ◽  
Afshin Razi ◽  
Nirmal Tejwani
Keyword(s):  
Compartment Syndrome ◽  
Direct Measurement ◽  
Vascular Injury ◽  
Diastolic Pressure ◽  
Sensory Neuropathy ◽  
Potential Complication ◽  
Compartment Pressure ◽  
Compartment Pressures ◽  
Frequent Presence

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. The purpose of this article is to summarize and review the existing literature on this entity. Long-term sequelae of foot compartment syndrome (FCS) include contractures, deformity, weakness, paralysis, and sensory neuropathy. These complications are poorly tolerated, and often necessitate multiple procedures for rehabilitation. Therefore, the threshold for considering compartment syndrome and performing fasciotomy must be low to minimize such outcomes. The existence of nine foot compartments and frequent presence of complicating injuries necessitate multi-stick needle catheterization for direct measurement of compartment pressures. Fasciotomy is indicated when compartment pressure exceeds 30 mmHg, or if compartment pressure is greater than 10–30 mmHg below diastolic pressure. The approaches for compartment decompression generally include two dorsal incisions for access to forefoot compartments, and one medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments.

scholarly journals The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

2014 ◽  
Vol 8 (1) ◽  
pp. 185-193 ◽  
Author(s):  
James Donaldson ◽  
Behrooz Haddad ◽  
Wasim S Khan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Surgical Decompression ◽  
Acute Compartment Syndrome ◽  
Definitive Treatment ◽  
Interstitial Pressure ◽  
Compartment Pressure ◽  
Current Management ◽  
Ischaemic Damage

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

scholarly journals Can Extravasation Injury Cause Subcutaneous Compartment Syndrome of the Hand?

2017 ◽  
Vol 3 ◽  
pp. 2513826X1772825
Author(s):  
Victor W. Wong ◽  
Philip J. Hanwright ◽  
Michele A. Manahan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Acute Compartment Syndrome ◽  
Tissue Loss ◽  
Rapid Improvement ◽  
Subcutaneous Space ◽  
Cutaneous Perfusion ◽  
Compartment Pressures

Background: Compartment syndrome of the hand is a well-described phenomenon with potentially devastating consequences. Although numerous mechanisms have been proposed, the extravasation of peripheral intravenous (IV) fluids remains a relatively rare etiology. Objective: Surgical dogma mandates emergent decompressive fasciotomies in the presence of hand dysfunction and impending tissue loss from supraphysiologic compartment pressures. The role of the subcutaneous space in acute compartment syndrome remains unclear. Methods: In this report, we present a case of a dorsal hand IV extravasation leading to an acute compartment syndrome of the subcutaneous space. Results: An emergent skin-only incision was used for decompression, with immediate improvement in symptoms and no long-term adverse sequelae. Discussion: The subcutaneous space appears capable of sustaining supraphysiologic pressures that impair cutaneous perfusion. This closed anatomic space can be readily decompressed, resulting in rapid improvement in soft tissue perfusion. However, its role in contributing to acute compartment syndrome of the hand requires further research. Conclusion: We propose consideration of the subcutaneous space as a distinct hand compartment and advocate selective compartment release when prudent.

Evaluation of Clinical and Venous Blood Parameters as Surrogate Indicators in Assessing the Need for Fasciotomy in Lower Limb Compartment Syndrome

2021 ◽  
pp. 153473462110590
Author(s):  
Rituparna Dasgupta ◽  
Nishith M. Paul Ekka ◽  
Arghya Das ◽  
Vinod Kumar
Keyword(s):  
Compartment Syndrome ◽  
Lower Limb ◽  
Venous Blood ◽  
Acute Compartment Syndrome ◽  
Neurological Deficits ◽  
Fisher Exact Test ◽  
Compartment Pressure ◽  
Exact Test ◽  
Significant Difference ◽  
Compartment Pressures

Acute compartment syndrome in the lower limb, a surgical emergency, may cause ischemic damage to muscles and neurological deficits leading to loss of function of the limb which may even require amputation, thus drastically affecting the quality of life of a patient. Fasciotomy for decompression is suggested when the differential pressure in the compartment of the leg is ≤30 mm Hg. However, compartment pressure measurement is not always feasible. Surgeons often find themselves in a dilemma in deciding the right treatment option for the patient: fasciotomy or conservative management. Since there is no universally accepted reference standard for the diagnosis of acute compartment syndrome at present, there is a need for definitive diagnostic variables so as to not delay fasciotomy in patients who need it, as well as to avoid unnecessary fasciotomies, especially when compartment pressures cannot be measured. In this observational study including 71 patients, based on the compartment pressures of the affected limb, treatment was done either with fasciotomy or conservative approach, and various clinical and biochemical parameters were evaluated in between these two groups. Statistically significant difference was found in the venous blood gas parameters between patients managed conservatively and with fasciotomy (MANOVA, P = .001). The results revealed the association of lower venous blood bicarbonate levels (independent sample t test, P = .021) and the presence of paresthesia (Fisher exact test, P = .0016) with the fasciotomy group. Also, pain on passive stretching of the affected limb was found to be significantly associated with a delta pressure of ≤30 mm Hg in any compartment (Fisher exact test, P = .002). These variables may thus be used as an alternative to the measurement of compartment pressure to assess the requirement of fasciotomy.

Compartment syndrome as a complication of intra-aortic balloon pumping

Perfusion ◽  
1986 ◽  
Vol 1 (3) ◽  
pp. 209-212
Author(s):  
JR Crockett ◽  
B. Glenville ◽  
JG Bennett
Keyword(s):  
Cardiac Output ◽  
Coronary Artery ◽  
Compartment Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Compartment Pressure ◽  
Low Cardiac Output ◽  
Set Up ◽  
Compartment Pressures

Intra-aortic balloon pumping (IABP) is a well accepted therapy in low cardiac output states. The complications reported with the use of IABP are varied. Development of a swollen, tender calf and loss of sensation and/or function, yet retaining a warm limb with the palpable peripheral pulses during or immediately after IABP is one such complication. We believe that this represents compartment syndrome following temporary or partial ischaemia. We set out to measure the compartment pressure in 13 patients in whom IABP was used following coronary artery bypass graft surgery. Our results show that the slit catheter method used in this study to measure compartment pressures gave reliable results, was easy to set up and use and provided early warning of compartment syndrome, thus facilitating early treatment and viability of all limbs affected.

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

2019 ◽  
Vol 40 (7) ◽  
pp. 853-858
Author(s):  
Reuben Lufrano ◽  
Matt Nies ◽  
Beau Ebben ◽  
Scott Hetzel ◽  
Robert V. O’Toole ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Primary Outcome ◽  
Acute Compartment Syndrome ◽  
Soft Tissue Coverage ◽  
Pressure Measurements ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
Fresh Frozen ◽  
Compartment Pressures ◽  
Theoretical Risk

Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.

scholarly journals Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

2020 ◽  
Vol 7 (10) ◽  
pp. 3374
Author(s):  
Neeraj K. Agrawal ◽  
Preeti Agrawal ◽  
Rahul Dubepuria
Keyword(s):  
Compartment Syndrome ◽  
Upper Limb ◽  
Road Traffic ◽  
Objective Assessment ◽  
Road Traffic Injury ◽  
Neurological Dysfunction ◽  
Deep Fascia ◽  
Compartment Pressure ◽  
Before And After ◽  
Compartment Pressures

Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.

Inhibition of Ras/ERK1/2 pathway contributes to the protective effect of Ginsenoside Re against intimal hyperplasia

2021 ◽  
Author(s):  
Chenying Gao ◽  
Kaina Zhang ◽  
Fanfan Liang ◽  
Wenzhuo Ma ◽  
Xixi Jiang ◽  
...  
Keyword(s):  
Protective Effect ◽  
Endovascular Treatment ◽  
Carotid Stenosis ◽  
Vascular Injury ◽  
Intimal Hyperplasia ◽  
Neointimal Hyperplasia ◽  
Ginsenoside Re ◽  
Term Efficacy

Neointimal hyperplasia is the major cause of carotid stenosis after vascular injury, which restricts the long-term efficacy of endovascular treatment and endarterectomy in preventing stenosis. Ginsenoside Re (Re) is a...

Treatment of Renal-Vascular Injury by Transcatheter Embolization: Immediate and Long-Term Effects on Renal Function

2006 ◽  
Vol 20 (6) ◽  
pp. 405-409 ◽  
Author(s):  
Vassilis Poulakis ◽  
Nikolaos Ferakis ◽  
Eduard Becht ◽  
Charalabos Deliveliotis ◽  
Markus Duex
Keyword(s):  
Renal Function ◽  
Vascular Injury ◽  
Transcatheter Embolization ◽  
Long Term Effects ◽  
Renal Vascular

Venomous Bites and Stings

2018 ◽  
Author(s):  
J Patrick Walker
Keyword(s):  
Significant Morbidity ◽  
Tissue Necrosis ◽  
Black Widow ◽  
Significant Treatment ◽  
The Us ◽  
Bites And Stings ◽  
Life Threatening ◽  
Compartment Pressures ◽  
Widow Spider

Approximately 8000 persons are bitten by venomous snakes in the US each year.  Mortality is low (4 to 6/yr), but morbidity can be significant, treatment costly. Overuse of surgery and antivenom is common. Simply cutting the wound with attempted aspiration is not indicated. Fasciotomy should only be used for patients with elevated compartment pressures. CroFab is a highly effective (but expensive) treatment useful for serious envenomation. Antivenom should be used in patients with life-threatening symptoms (hypotension, clinical coagulopathy) or rapid advancement of local signs, and to reduce compartment pressures to avoid fasciotomy. The most significant morbidity from insect envenomation is secondary to anaphylaxis. A bite from the black widow spider can induce abdominal cramping and pain that can mimics an acute abdomen. Brown recluse envenomation can produce tissue necrosis and long-term complications. Most events are seen rarely by the average physician; this review can be a useful guide in management.  Key words: antivenom, copperhead bite, CroFab, insect bite, rattlesnake bite, snakebite, water moccasin bite

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