Compartment Syndrome PDF

Compartment Syndrome Dr. Ashraf El Shayeb Consultant Plastic Surgery Assistant Professor of Surgery Arabian Gulf University  Compartment Syndrome A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within t...

Compartment Syndrome Dr. Ashraf El Shayeb Consultant Plastic Surgery Assistant Professor of Surgery Arabian Gulf University  Compartment Syndrome A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space. * Anterior compartment syndrome: It is a condition in which the high pressure within closed anterior muscle compartment of the leg compromises the circulation to the muscles, compress its nerves and affect the circulation distally.  Compartment Syndrome Lower Leg 4 compartments – Lateral. – Anterior – Superficial posterior – Deep posterior  Compartment Syndrome Etiology / Pathophysiology Compartment Size Localized external pressure: Tight dressing; Bandage/Cast Tight closure of fascial defects Compartment Content Bleeding/ Hematoma: fracture, vascular injury. Increased Capillary Permeability: Trauma / Burns / Snake Bite  Compartment Syndrome Etiology Fractures Hemophilia / coag. Blunt trauma disorder Tight Cast or dressing Snake bite Closure of fascial Arterial injury defects Burns / electrical  Compartment Syndrome Tissue Survival Muscle – < 3-4 hours - reversible changes – > 6-8 hours - irreversible changes (death of the muscle). Nerve – 2-4 hours – reversible changes (neuropraxia). – 8 hours - irreversible changes  Compartment Syndrome Diagnosis 5Ps Pain – Pallor – Paresthesia – Pulseless - Paralysis Pain out of proportion: tense Calf muscles of the leg. Pallor Paresthesia / Hypoesthesia: (No or decreased sensation). Pulseless Paralysis  Clinical Evaluation Pain – most important. Especially pain out of proportion to the injury Most reliable signs are pain on passive stretching and pain on palpation of the involved compartment Other features like pallor, pulselessness, paralysis, paresthesia … etc. appear very late and we should not wait for it to diagnose Compartment Syndrome.  How to measure the pressure inside the compartment ? A special catheter is inserted into the muscle compartment that wanted to be measured and the catheter is connected to a machine that digitally record the pressure. Normal tissue pressure – 0-4 mm Hg (up to 10 with exertion). Absolute pressure to diagnose CS – 30 mm Hg  General Management Remove circumferential bandages and full cast Maintain the limb at level of the heart as elevation reduces the arterial inflow and accordingly tissue perfusion. Supplemental oxygen administration. Urgent / Bed side Fasciotomy : to avoid permanent damage to the muscles and nerves.  Surgical Treatment Fasciotomy, Fasciotomy, Fasciotomy Incision of the skin, subcutaneous tissue and deep fascia for release of pressure before permanent damage occurs.  Indications for Fasciotomy Pressure within 15-20 mm Hg Rising pressure inside the compartment Significant tissue injury > 6 hours of total limb ischemia Injuries at high risk of compartment syndrome (fractures or severe blunt trauma).  Fasciotomy Principles Make EARLY diagnosis Long extended incisions at both sides of the leg (skin, subcutaneous tissue and deep fascia) Release all fascial compartments Preserve neuro-vascular structures Keep the wound opened + antibiotic Skin closure or coverage with skin graft within 7-10 days Fasciotomy: leg, medial side Gastroc-soleus Flexor digitorum longus Fasciotomy: leg, lateral side Intermuscular septum Superficial peroneal nerve  Summary Keep a high index of suspicion Treat as soon as you suspect Compartment Syndrome If clinically evident, do not measure the pressure Fasciotomy – The only treatment for compartment syndrome, when performed on time Thank You