In a study evaluating their institutional experience with compartment syndrome, Gonzalez et al 10 showed that no patients with distal below knee penetrating injuries developed compartment syndrome, whereas 27% of patients with a proximal below knee penetrating injury eventually required fasciotomy. 9 The specific location of injury is important in predicting development of compartment syndrome. The below knee leg is the most likely compartment to develop acute compartment syndrome, followed by the forearm, thigh, and arm. 8Ĭompartment syndrome can occur in any area of the body with closed compartments. Interestingly, a cohort of 11 patients had an injury-to-fasciotomy time of >24 hours and did not develop any tissue necrosis, so likely the degree of intracompartmental pressure is also a factor in determining outcomes. In patients brought to the operating room within 3 hours, 50% had evidence of muscle necrosis. 6 7 Vaillancourt et al 8 retrospectively correlated the total time of ischemic insult to tissue with subsequent tissue necrosis seen on fasciotomy. 5 Ischemia of up to 6 hours is associated with irreversible necrosis and more likely to produce functional impairment. Tissue ischemia of only 1 hour is associated with reversible neuropraxia, whereas ischemia of 4 hours can induce irreversible axonotmesis. In general, longer periods of compartment syndrome and ischemia correlate with worse outcomes. Interstitial edema develops from tissue necrosis and further worsens compartmental swelling. Capillary collapse occurs when the compartment pressure surpasses the capillary perfusion pressure, leading to cellular ischemia and necrosis. 4 Intracompartmental bleeding leads to increased intracompartmental pressure, which increases venous capillary pressure. This was further elucidated and better characterized by Carter et al 3 in 1949 as muscle trauma leading to increased pressure within a muscular compartment that impairs blood supply, leading to necrosis.Ĭompartment syndrome occurs when the pressure within a defined compartmental space increases past a critical pressure threshold, thereby decreasing the perfusion pressure to that compartment. Labeled initially as a crush injury with impairment of renal function, the authors describe a swollen limb developing into shock, diminished pulse in the injured extremity, impending limb gangrene, progressive renal failure, and ultimately death. Bywaters and Beall better 2 defined the disease of compartment syndrome in a case series of British World War II victims in 1941. 1 The prevailing theory at the time was that tight bandages caused the ischemic insult. His landmark article detailed ischemia to a limb that when left untreated for several hours led to paralytic contracture. The sequela of compartment syndrome left untreated was first described by Volkmann in 1881. Rapid diagnosis and prompt, accurate treatment lead to the best outcomes. Lower extremity compartment syndrome is not uncommon and has the potential to cause devastating morbidity for patients and a high-risk medical-legal environment for physicians.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |