Professional Documents
Culture Documents
Syndromes
Compartment Syndrome
Definition
Elevated tissue pressure within a closed fascial
space
Reduces tissue perfusion
Results in cell death
Pathogenesis
Too much inflow (edema, hemorrhage)
Decreased outflow (venous obstruction, tight
dressing/cast)
Compartment Syndrome
Historical Review
Late complications of ischemic contracture
Volkmann, 1881
Ischemia of forearm
venous stasis leading
to irreversible contracture
Ellis, 1958; Seddon, 1966
Lower extremity
Retrospective reviews
Advised the early recognition of the syndrome and
fasciotomies of the affected limbs
Compartment Syndrome
Pathophysiology
Normal tissue pressure
0-4 mm Hg
8-10 with exertion
Absolute pressure theory
30 mm Hg - Mubarak
45 mm Hg - Matsen
Pressure gradient theory
< 20 mm Hg of diastolic pressure Whitesides
McQueen, et al
Compartment Syndrome
Tissue Survival
Muscle
3-4 hours - reversible changes
6 hours - variable damage
8 hours - irreversible changes
Nerve
2 hours - looses nerve conduction
4 hours - neuropraxia
8 hours - irreversible changes
Compartment Syndrome
Etiology
Arterial occlusion
Muscle rupture
Compartment Syndrome
Pressure Measurements
Anatomy-3 compartments
Mobile wad-BR,ECRL,ECRB
Volar-Superficial and deep flexors, Pronator
teres, Supinator
Dorsal-Extensors
Forearm Fasciotomy
Volar-Henry approach
Include a carpal tunnel
release
Release lacertus
fibrosus and fascia
Forearm Fasciotomy
Protect median nerve,
brachial artery and
tendons after release
Consider dorsal
release
Compartment Syndrome
Leg Anatomy
4 compartments
Lateral: Peroneus longus and brevis
Anterior: EHL, EDC, Tibialis anterior,
Peroneus tertius
Posterior-Gastrocnemius, Soleus
Deep posterior-Tibialis posterior, FHL, FDL
Leg Fasciotomies
Generous skin
incisions
medial
lateral
Release completely
all 4 fascial
compartments
Beware of
neurovascular
structures to prevent
iatrogenic injury
Fasciotomy: Medial Leg
Gastroc-soleus
Flexor digitorum
longus
Fasciotomy: Lateral Leg
Intermuscular septum
Lateral septum
Compartment Syndrome
Foot
Four major compartments
Multiple layers
Careful exam with any swelling
Clinical suspicion with certain mechanisms
of injury
Lisfranc fracture dislocation
Calcaneus fracture
Compartment Syndrome
Foot Fasciotomies
Dorsal incision-to
release the
interosseous, central
and lateral
compartments
Medial incision-to
release the medial
compartment
Compartment Syndrome
Other Areas
Can occur anywhere in the body
Hand-dorsal incisions, thenar, hypothenar
Arm-lateral incision
Buttock-posterior (Kocher) approach
Abdominal- with the Trauma surgeons
Interim Coverage Techniques
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