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.

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.

A RAPID AND CONVENIENT METHOD FOR DETERMINING LIMB COMPARTMENT PRESSURE

2011 ◽  
Vol 23 (06) ◽  
pp. 435-444
Author(s):  
William Chu ◽  
Jiun-Hung Lin ◽  
Shih-Tsang Tang ◽  
Woei-Chyn Chu ◽  
Shuenn-Tsong Young ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Convenient Method ◽  
Strong Correlation ◽  
Cell Damage ◽  
Measurement Instrument ◽  
Critical Value ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
Wall Displacement ◽  
Cells Death

Compartment syndrome (CS) is the pressure increasing within a confined anatomic space, which results in ischemia to the encompassed tissues and then leads to cells death. If left untreated, CS results in irreversible cell damage, further permanently postischemic scarring and contracture. The intracompartmental pressure is a major diagnostic consideration. Various methods of compartment pressure (CP) measurement have been developed since the late 1800s. They can be classified into invasive and noninvasive categories. Invasive methods are accurate but painful; whereas noninvasive approaches are more comfortable but less accurate. Both methods provide reproducible outcomes but also require specific CP measurement instrument to be performed. This research proposes a rapid and convenient method via examining ultrasonographic fascia wall displacement. For the viscoelastic nature of the compartment fascia, our experiment results have shown the ultrasonographic fascia displacement accurately reflects even small changes of the compartment diameter. There is a strong correlation between compartment pressure and fascia displacement ratio. It also recommends that the ratio of 1.4 could be chosen as the critical value for determining acute compartment syndrome. These results suggest that ultrasonography may serve as an adequate noninvasive tool to monitor CP variations.

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.

Correlation Between Muscle Oxygenation and Compartment Pressures in Acute Compartment Syndrome of the Leg

2010 ◽  
Vol 92 (4) ◽  
pp. 863-870 ◽  
Author(s):  
Michael S Shuler ◽  
William M Reisman ◽  
Tracy L Kinsey ◽  
Thomas E Whitesides ◽  
E Mark Hammerberg ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Acute Compartment Syndrome ◽  
Muscle Oxygenation ◽  
Compartment Pressures

scholarly journals Compartment pressure changes after closed fractures of tibia

2016 ◽  
Vol 2 (3) ◽  
pp. 188
Author(s):  
Manju G. Pillai
Keyword(s):  
Compartment Syndrome ◽  
Great Majority ◽  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
College Hospital ◽  
Medical College ◽  
Closed Fractures ◽  
Upper Third

<p><strong>Background: </strong>Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.</p><p><strong>Methods:</strong> The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months.  Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. </p><p><strong>Results:</strong> The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.</p><strong>Conclusion:</strong> Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

Monitoring and interpreting compartment pressures in acute compartment syndrome

Trauma ◽  
2012 ◽  
Vol 14 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Tom Barker ◽  
Mark Midwinter ◽  
Keith Porter
Keyword(s):  
Compartment Syndrome ◽  
Acute Compartment Syndrome ◽  
Compartment Pressures
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