DETERMINATION OF CLINICAL INDICATORS OF INTERSTITIAL PRESSURE IN DEEP AND BORDERLINE BURNS DEPENDING ON THE TIME OF THERMAL INJURY

2020 ◽  
pp. 44-50
Author(s):  
O. V. Kravtsov ◽  
T. A. Kurbanov ◽  
Yu. I. Kozin ◽  
A. A. Tsogoev ◽  
A.O. Gopko
Keyword(s):  
Compartment Syndrome ◽  
Thermal Injury ◽  
Infusion Therapy ◽  
Superficial Fascia ◽  
Interstitial Pressure ◽  
Drug Infusion ◽  
Tissue Pressure ◽  
Clinical Indicators ◽  
Ischemic Tissue ◽  
Muscle Groups

Summary. Objective. Improvement of the diagnosis of compartment syndrome depending on the time of thermal injury and the establishment of indications for draining operations. Materials and methods. Interstitial pressure was studied in 66 victims who were admitted to the burn center in the first 24 hours after the injury. The patients were divided into groups depending on the relative extent of the lesion and the length of hospitalization. The results of the study and their discussion. Upon admission of the patient to the department, a thorough sanitation of the burn surfaces was performed with antiseptic solutions (chlorhexidine, dekasan). In the burn area, the interstitial pressure was measured in all muscle groups deeper than the superficial fascia with a Kompartment druck Monitor System (MIPM Mammen dorfer Institut für Physik und Medizin Gmbh) apparatus for measuring interstitial pressure. Depending on the level of interstitial pressure, patients underwent conservative drug and infusion therapy aimed at reducing edema and hypoxia of damaged tissues. In the case of critical indicators of interstitial pressure, an urgent surgical intervention was performed for the purpose of decompression. When assessing the dependence of the pressure level in the tissues on the timing of burns, there is a clear dependence in all observation groups: late hospitalizations are accompanied by a large increase in pressure, the level of circular location of burns on the extremities is of great importance for high blood pressure. Conclusion. It has been determined that objectification of the diagnosis of the compartment syndrome in order to prevent ischemic tissue damage plays an important role in deep and borderline burns. Clinical indicators of tissue pressure in deep and borderline burns have been established, depending on the time of thermal injury, which allows the diagnosis of compartment syndrome and the establishment of indications for drug, infusion therapy and urgent drainage operations.

scholarly journals EXPERIMENTAL STUDY OF CLINICAL INDICATORS OF INTRATISSUE PRESSURE IN DEEP CIRCULAR BURNS AND ITS DYNAMICS DEPENDING ON THE NATURE AND VOLUME OF SURGERY

2021 ◽  
pp. 22-26
Author(s):  
O. V. Kravtsov ◽  
T. A. Kurbanov ◽  
Yu. I. Kozin
Keyword(s):  
Experimental Study ◽  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Radical Excision ◽  
Tissue Pressure ◽  
Clinical Indicators ◽  
Experimental Animals ◽  
Rapid Decompression ◽  
Surgical Tactics

The purpose of research. To improve in the experiment the optimal variants of surgical tactics to eliminate the phenomena of compartment syndrome in circular deep burns on the basis of studying the dynamics of intratissue pressure. Materials and methods. An experiment to study the effectiveness of treatment of deep circular burns of III degree, accompanied by compartment-syndrome with objectification of intra-tissue pressure was performed on 18 male WAG rats weighing 190.0-200.0 g, which were divided into three groups depending from the nature and scope of surgery. Research results and their discussion. Based on the assessment of the dependence of the level of intratissue pressure in the tissues on the timing of modeling of deep circular burns in the experiment and tactics and volume of surgical treatment, a clear dependence of indicators in all groups of experimental animals. The primary necrectomy performed in the III main group due to the radical surgical intervention allowed to completely normalize the intratissue pressure within 24 hours. Conclusions. 1. Clinical indicators of intratissue pressure at deep circular burns depending on time of modeling of a thermal trauma and character and volume of surgical intervention are defined in experiment. 2. It is established that primary necrectomy due to radical excision of necrotized tissues and rapid decompression contributes to the nor malization of intratissue pressure.

scholarly journals CLINICAL DYNAMICS OF TISSUE CHANGES IN THE FORMATION OF COMPARTMENT SYNDROME IN BURNS

2020 ◽  
pp. 44-49
Author(s):  
V. V. Boiko ◽  
T. A. Kurbanov ◽  
O. V. Kravtsov ◽  
Yu. I. Isaev ◽  
E. A. Kravtsova
Keyword(s):  
Compartment Syndrome ◽  
Thermal Injury ◽  
Soft Tissues ◽  
Positive Impact ◽  
Physiological Saline ◽  
Morphological Development ◽  
Interstitial Pressure ◽  
Tissue Changes ◽  
Therapeutic Measures ◽  
Electric Burns

Summary. Compartment syndrome — local hypertensive-ischemic syndrome - a formidable complication of traumatic tissue damage, the basis of which is the increase in intrafascial pressure of muscle masses above 20 mm. The treatment of this dangerous condition is carried out by emergency surgery to decompress tissues. The aim of the study was to study in an experiment the clinical and morphological development of the compartment syndrome for burns and to evaluate the effectiveness of necrotomy operations and impregnation of affected tissues with ozonized physiological saline. Materials and methods. The experiment was carried out on 18 rats of the WAG line, weighing 190-210 g. The study material was skin with adjacent soft tissues of the thigh area. To simulate experimental deep burns, we used a device developed by us for the formation of burns, standard in depth and area of the lesion. After the burn was formed, interstitial pressure was measured. Research results and discussion. The dynamics of macroscopic observations of the wound process and x-ray studies reflect their correspondence to the severity of thermal injury and the positive impact of the proposed therapeutic measures. Сonclusions. The development of the compartment syndrome with circular and subcircular limb burns and electric burns is a formidable complication, leading to a sharp deterioration in thermal injury and requires immediate surgical intervention. The critical point of the level of interstitial pressure should be considered 20 mm, the increase is an absolute indicator for the operation. The effectiveness of necrotomy can be improved by the use of a number of medications, in particular local infiltration with ozonized saline.

MORPHOLOGICAL EVALUATION OF EFFECTIVENESS OF NECROFASCIOTOMY AND INFILTRATION WITH OZONATED SALINE AREA OF DEEP CIRCULAR BURN OF SKIN WITH UNDERLYING TISSUES COMPLICATED BY COMPARTMENT SYNDROME

2020 ◽  
pp. 28-33
Author(s):  
Teimur Ahaliievich Kurbanov ◽  
O. V. Kravtsov ◽  
M. S. Myroshnychenko ◽  
Yu. I. Isaev
Keyword(s):  
Compartment Syndrome ◽  
Physiological Solution ◽  
Burn Wound ◽  
Local Pressure ◽  
Tissue Pressure ◽  
Surgical Interventions ◽  
Morphological Evaluation ◽  
General Pathology ◽  
Saline Area ◽  
The One

Compartment syndrome is one of the complications of tissue damage of various origins, the basis of which is the compression of blood vessels and disruption of blood supply to tissues due to an increased local pressure in the closed space of the fascial sheath. The consequences of compartment syndrome can be local and general. An effective treatment of compartment syndrome in burns is to perform a necrotomy, which due to decompression helps to reduce intra−tissue pressure and diminish the scale of necrotic changes in tissues. In order to morphologically evaluate the effectiveness of necrofasciotomy, as well as the one in combination with infiltration of ozonated saline area of deep circular skin burns with underlying tissues, complicated by compartment syndrome, an experimental study was conducted. Circular deep burns, complicated by the formation of compartment syndrome, were simulated in 18 WAG rats. To reduce the pressure in the burned and surrounding tissues, surgical interventions such as necrofasciotomy were performed, which provided a notable reduction in pressure. In parallel, infiltration of damaged tissues with ozonated saline was performed, which was bubbled for 15 minutes at a dissolved ozone concentration of 4.0±0.2 mg / l, which improved microcirculation and reduced tissue hypoxia. The findings indicate that the compartment syndrome is characterized by a significant severity of general pathology. Performance of necrofasciotomy of a burn wound with its infiltration by ozonated physiological solution in comparison with just necrofasciotomy has more positive medical effect, and efficiency of these medical measures increases when they are performed at early terms (day 1) of formation of a burn wound in comparison with late terms (day 3). Key words: burns, surgical treatment, compartment syndrome, histological examinations.

Bilateral Gluteal Compartment Syndrome: A Rare but Potentially Morbid Entity

2010 ◽  
Vol 76 (7) ◽  
pp. 752-754 ◽  
Author(s):  
Jose Castro-Garcia ◽  
Brian R. Davis ◽  
Miguel A. Pirela-Cruz
Keyword(s):  
Compartment Syndrome ◽  
Operating Room ◽  
Illicit Drug ◽  
Early Recognition ◽  
Lumbar Pain ◽  
Interstitial Pressure ◽  
Sensory Deficits ◽  
Illicit Drug Abuse ◽  
The Right ◽  
Gluteal Compartment Syndrome

Compartment syndrome is caused by elevated interstitial pressure within the myofascial compartment. It rarely presents bilaterally in the gluteal region. A 49-year-old man fell 10 feet from a roof on his buttocks. He presented 10 hours after the injury with intense lumbar pain. Both glutei were exceptionally tense. There were no vascular injuries or sensory deficits. Compartmental pressures measured 60 mm Hg on the left side and 50 mm Hg on the right side. The patient was taken to the operating room for decompressive fasciotomy. The glutei compartments were released. He was taken once more to the operating room, requiring only minimal debridement. He was discharged the next week with no neurological deficit. Bilateral gluteal compartment syndrome is very rare with few cases reported in the literature. It has been associated with trauma, prolonged recumbence, surgical instrumentation, and illicit drug abuse. Early recognition is required to avoid the potential severe metabolic and physical deficits.

Tissue pressure as a causal factor in the autoregulation of blood flow in the isolated perfused kidney

1959 ◽  
Vol 197 (2) ◽  
pp. 309-312 ◽  
Author(s):  
Lerner B. Hinshaw ◽  
Stacey B. Day ◽  
Curtis H. Carlson
Keyword(s):  
Blood Flow ◽  
Arterial Pressure ◽  
Renal Artery ◽  
Interstitial Pressure ◽  
Tissue Pressure ◽  
Vascular Volume ◽  
Flow Through ◽  
Vascular Beds ◽  
The Difference ◽  
Bowman's Capsule

Experiments were performed on isolated perfused dog kidneys to determine relationships between tissue pressure, vascular volume, ‘over-all’ and ‘intraorgan’ vascular resistances. Results indicate that autoregulation of renal blood flow is brought about by disproportionately large increases in extravascular pressure. Since extravascular and intravascular pressures are opposing forces there is progressively less vascular distention with increases in arterial pressure as the increments in extravascular pressures approach the increments in intravascular pressures. The effective propellent force of blood flow through the kidney is thought to be the difference between the renal artery pressure and extravascular pressure. Vascular resistances calculated on this basis showed no significant changes throughout the range of autoregulation in four of the six experiments. It is proposed that the extravascular pressure within Bowmans capsule may exceed the renal interstitial pressure, and when the effects of renal extravascular pressures within and without Bowman's capsule are taken into account in the calculation of intrarenal vascular resistance, the pressure-flow relations of the kidney will be similar to those of other vascular beds.

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.

Marked increase of plasma hyaluronan after major thermal injury and infusion therapy

1991 ◽  
Vol 50 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Henning Onarheim ◽  
Anne E. Missavage ◽  
Robert A. Gunther ◽  
George C. Kramer ◽  
Rolf K. Reed ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Infusion Therapy

INTENSIFICATION OF COMBINED THERAPY IN PATIENTS WITH FOOT PHLEGMON

2019 ◽  
pp. 28-33 ◽  
Author(s):  
A.V. Edilov ◽  
V.K. Tat'yanchenko ◽  
V.L. Bogdanov ◽  
Yu.V. Sukhaya
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Clinical Laboratory ◽  
Combined Therapy ◽  
Diagnostic Algorithm ◽  
High Strength ◽  
Diagnosis And Treatment ◽  
Efficacy Evaluation ◽  
Tissue Pressure ◽  
Group I

The purpose of the work is to improve surgical treatment of foot phlegmon by developing a method for diagnosis and treatment of compartment syndrome (CS). Materials and Methods. The study involved 64 patients with foot phlegmon of non-diabetic etiology. The patients were divided into two groups. Group I (control, n=31) suggested traditional treatment techniques. Group II (main, n=33) provided a new algorithm for the diagnosis and treatment of compartment syndrome (patent No. 2683855), along with ultrasonic cavitation and ozone therapy. To assess the severity of the purulent-inflammatory process in the foot, the authors suggested to include a tissue pressure measurement technique in the diagnostic algorithm. The obtained indicators contributed to the diagnosis of the compartment syndrome and, thus, administration of decompressive fasciotomy in fascial foot structures with a high strength level and elastic modulus. The authors also evaluated the degree of reparative processes in the postoperative wound and the level of its microbial contamination (CFU calculation). Results. It was estimated that the increase in tissue pressure by more than 25 mm Hg in 87.9 % of patients is an indication for a know-how decompressive fasciotomy. The obtained results of clinical, laboratory and instrumental research allowed the authors to develop an algorithm for treatment efficacy evaluation. Conclusion. The positive treatment results observed in 90.9 % of patients make it possible to recommend the developed algorithm for implementation in clinical practice. Keywords: phlegmon, tissue pressure, surgical treatment, fasciotomy. Цель работы – улучшение результатов хирургического лечения флегмоны стопы путем разработки способа диагностики и лечения компартмент-синдрома (КС). Материалы и методы. В исследовании участвовали 64 пациента с флегмоной стопы недиабетической этиологии, разделенных на две группы. В I группе (контрольной, n=31) использовалась традиционная методика лечения, во II группе (основной, n=33) – разработанный алгоритм диагностики и лечения компартмент-синдрома (патент на изобретение № 2683855), а также методы ультразвуковой кавитации и озонотерапии. Для оценки тяжести течения гнойно-воспалительного процесса в области стопы было предложено включить в диагностический алгоритм методику измерения тканевого давления. Полученные показатели послужили основанием для диагностики компартмент-синдрома и выполнения по показаниям декомпрессивной фасциотомии в области фасциальных структур стопы, обладающих высокими уровнем прочности и модулем упругости. Также оценивались степень репаративных процессов в послеоперационной ране и уровень ее микробной обсемененности по значению КОЕ. Результаты. Установлено, что увеличение тканевого давления более чем на 25 мм рт. ст. у 87,9 % пациентов является показанием для выполнения декомпрессивной фасциотомии по оригинальной методике. Полученные результаты клинических, лабораторных и инструментальных методов исследования позволили выработать алгоритм оценки эффективности лечения. Выводы. Отмеченные у 90,9 % пациентов хорошие результаты лечения дают возможность рекомендовать разработанный алгоритм для внедрения в клиническую практику. Ключевые слова: флегмона, тканевое давление, хирургическое лечение, фасциотомия.

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