Академический Документы
Профессиональный Документы
Культура Документы
Andre H Simarmata
11-2013-145
Overview of Compartment
Syndrome
Compartment syndrome occurs when
extremely high pressures build in
confined space
Blood supply is dramatically reduced to
muscles in a closed body space, known as
a compartment. Compartments are
found in the hand, forearm, upper arm,
abdomen, buttock and leg.
The muscles most frequently involved are
those on the front of the lower leg or
palm side of the forearm.
compartment syndrome is an
emergency
Objective info:
Pallor
Pulselessness
Paresis
Diagnosis
A swollen limb,
tense on palpation,
in an intrinsic
minimus position
strongly indicates
compartment
syndrome.
Diagnosis is based
on high degree of
clinical suspicion
Tissue Pressure
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
< 30 mm Hg of diastolic pressure McQueen,
et al
Tissue-Pressure:
Principles
Heckman et al
demonstrated that
pressure within a given
compartment is not
uniform
They found tissue pressures
to be highest at the site
or within 5cm of the
injury
3 of their 5 patients
requiring fasciotomies had
sub-critical pressure values
5cm from the site of highest
pressure
Pressure
Measurement
Infusion Arterial line
manometer 16 - 18 ga.
saline
Needle
3-way stopcock
(5-19 mm Hg
higher)
(Whitesides, CORR
transducer
1975)
monitor
Catheter
wick Stryker device
slit catheter Side port
needle
Needle Infusion Technique-Historical
Needle inserted into muscle,
tube with air/saline interval
kept at this height,
manometer indicates
pressure
Air injected by syringe via 3-
way stopcock
When the pressure of the saline
Two incisions
All
4
compartments
must be released
Not selective
One Incision
Alternatively, a straight
incision from lateral biceps to
radial styloid can be used.
Henry Approach
Care of NV structures
Henry Approach
Brachioradialis and
superficial radial n. are
retracted radially and
FCR and radial artery
are retracted ulnar to
expose the deep volar
muscles
exfix
Muscle weakness
Iatrogenic NV injury
Cosmetic concerns
Prognosis
Accurate and prompt
diagnosis is necessary to
assure a good outcome.
Only 8% of patients will
regain function if surgery
is delayed.
Little or no return of
function can be expected if
dx and tx are delayed.
Surgery performed days
after injury
contraindicated due to
If surgery performed severe infection and
within 12 hours after difficulty in managing
onset of acute CS, necrotic muscle.
prognosis is good.