Lower extremity compartments fasciotomy8/23/2023 Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality. The most commonly unopened compartment was the anterior compartment of the lower leg. The most common revision procedures were extension of fascial incisions and opening new compartments. We therefore compared two commonly used methods to close fasciotomy wounds, Epigard, a temporary synthetic skin replacement (SSR) and the vacuum-assisted closure (V.A.C. These patients also received more blood products at Landstuhl Regional Medical Center.įasciotomy revision was associated with a fourfold increase in mortality. Purpose No clear consensus on the optimal treatment of fasciotomy wounds due to acute compartment syndrome of the lower leg in children exists. Patients who underwent revisions or delayed fasciotomies had higher Injury Severity Score and larger burns as well as lower systolic blood pressure, acidosis, and more pressor use during air evacuation. 5%) than patients who received their fasciotomies in the combat theater (p < 0.01). Compartment syndrome (CS) following arterial vascular trauma (AVT) of the lower extremities can be caused by reperfusion injury following revascularization, direct soft tissue injury or hemorrhage into the fascial compartments due to bone fracture and/or the vascular injury itself 1. Patients who underwent fasciotomy after evacuation had higher rates of muscle excision (25% vs. The anterior and deep compartments of the lower leg were the most commonly unopened. Fasciotomy of the Leg 2-skin incision, 4-compartment fasciotomy. 6%, p < 0.01) than those who did not receive a revision. C, Drawing of thigh compartments and appropriate incision. Patients who underwent a fasciotomy revision had higher rates of muscle excision (35% vs. Most were to the lower leg (49%) and forearm (23%). Outcomes were rates of muscle excision, major amputation, and mortality.Ī total of 336 patients underwent 643 fasciotomies. Chronic exertional compartment syndrome (CECS), first described in 1912, is a rare clinical diagnosis that occurs more frequently in the lower extremity than the upper extremity.16 Lower-extremity CECS is most often observed in running athletes7 and marching military members. Patients in the lithotomy and lateral decubitus positions were more likely to have this problem than those in supine positions. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation.Ī retrospective review was performed of combat casualties who underwent fasciotomies in Iraq, Afghanistan, or at Landstuhl Regional Medical Center between Januand August 31, 2006. In summary, we found that compartment syndrome with no apparent cause necessitating fasciotomy occurred infrequently and in both the upper and lower extremities of patients in this surgical population. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Background: Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. Severe damage to the nerve and blood vessels around a muscle can cause the muscle to die and amputation might be necessary.Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. If the pressure becomes great enough, blood flow to the muscle can be blocked, leading to a condition known as compartment syndrome. One of the key steps is proper placement of the incisions. There are several key features that will enable a successful two-incision four-compartment fasciotomy. Blood vessels and nerves can also be affected by the pressure caused by any swelling in the leg. Compartment syndrome of the lower extremity dictates two-incision four-compartment fasciotomy with generous skin incisions 29, 44. The thickness of the fascia can give problems when any inflammation present in the leg has little room to expand into. Due to the great pressure placed on the leg, from the column of blood from the heart to the feet, the fascia is very thick in order to support the leg muscles. The fascia also separates the skeletal muscles from the subcutaneous tissue. The septa are formed from the fascia which is made up of a strong type of connective tissue. Įach compartment contains connective tissue, nerves and blood vessels. The lower leg is divided into four compartments by the interosseous membrane of the leg, the anterior intermuscular septum, the transverse intermuscular septum and the posterior intermuscular septum. All of the muscles within a compartment will generally be supplied by the same nerve. The compartments usually have nerve and blood supplies separate from their neighbours. The compartments are divided by septa formed from the fascia. The fascial compartments of the leg are the four fascial compartments that separate and contain the muscles of the lower leg (from the knee to the ankle).
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