E-learning Bedah FK UNS

FASCIOTOMY IN THE EXTREMITIES

S. Kamil

Compartment syndrome is characterized by excessive pressure of the neurovascular bundles and soft tissues occupying a closed space. Excessive pressure result in critical ischemia to muscles, veins, arteries, and nerves. Although this can happen in any closed space including the skull and the abdomen, focus will remain on compartment syndrome in the extremities. In 1881,Richard von Volkmann published an article describing contractures of the forearm flexor compartment (felt to be associated with tight bandages following supracondylar fracture) leading to arterial insufficiency and poor venous return. A variety of different compartment syndromes have been described in the upper and lower extremities. Compartment syndrome has been documented in the shoulder, arm, forearm, hand, buttock, thigh, leg, and foot.

Compartment syndrome develops as a result of a reduction of venous outflow. This can be correlated with local tissue edema directly compressing on venous outflow channels or direct injury to vessels as well. Reperfusion injury after vascular injury also causes tissue edema leading to the development of compartment syndrome. In the case of a fracture, a bleeding long bone and the development of a space occupying hematoma can exacerbate this situation.

Acute compartment syndrome usually follows trauma. The treatment is to decompress the compartment as soon as is feasible. This may simply involve removing circumferential dressings or pneumatic trousers or bivalving casts. More often, surgery is necessary. In order to eliminate a compartment syndrome, all compartments within an anatomical region should be decompressed. For example, in the lower leg, a four-compartment fasciotomy is typically necessary even if only one of the compartments has elevated pressures. After completion of the fasciotomy, many surgeons will staple vessel loops interwoven on the skin to synch the skin closed over the subsequent days as pressures and swelling decrease.

ARM

The arm or brachium is divided into an anterior and posterior compartment. Compartment syndromes of this region are rare. A single longitudinal incision along the length of posterior-medial aspect of the biceps brachii will allow for access into both compartments with adequate decompression. The basilic vein and medial brachial cutaneous nerves should be identified and preserved if possible.

(Edited by admin elearning - original submission Tuesday, 12 February 2013, 05:48 PM)

Free Visits Counter