Compartment syndrome and its treatment in peripheral arterial trauma
AbstractIntroduction: In each case with important peripheral vascular injury one of the crucial problems to be solved is the installation of the compartment syndrome. Material and methods: From August 1999 till March 2005 we treated 77 patients with important arterial injuries of the limbs . The range in age was from 13 to 65 years old . In 62 patients the injury was in lower limbs , in 15 the injury was in upper ones. The injuries were causalities of shotguns in 55 cases , knives and other sharp objects in 17 cases , road incidents in 4 cases and iatrogenic 2 cases. We performed fasciotomy in 29 cases. All of them in the legs. In the cases we performed fasciotomy complexity of trauma was 93 % . The rest of cases had a complexity of 15 %. Mean time of addmition in our department from the moment of trauma was 16.5 hours in fasciotomy group and 6. 5 hours in non fasciotomy group. In the cases with fasciotomy revascularization procedures have been performed in 85 % of patients. Whereas in the cases without fasciotomy revascularization procedures were performed in 100 % of cases. Results: In the cases treated with fasciotomy 26 patients did well versus 32 in non fasciotomy group. Amputation in different levels were performed in three cases in fasciotomy group and one in the other group. Neuropathy was installed in 2 patients with fasciotomy versus 1 patient without fasciotomy. Muscular necrosis suffered 3 patients with fasciotomy. Mean duration of stay in hospital was 19 days in the group with fasciotomy and 10 days in the group without. Conclusions Fasciotomy should be performed as soon as possible in all cases where a compartment syndrome is installed.
Vitale GC, Richardson DJ, George SM et al: Fasciot- omy for severe blunt and penetrating truma of the extremity, Surg Gynecol Obstet 166:397-401, 1998.
Perry MO: Compartment syndrome and reperfusion injury, Surg Clin North Am 68:853-864, 1997.
Compartmental syndromes,J Bone Joint Surg Am 62:286-291, 1980.
Williams AB, Luchete FA, Papaconstantinou HT et al: The effect of early versus late Fasciotomy in the management of extremity trauma, Arch Surg 133:547551,1998.
Abouezzi Z, Nassoura Z, Ivatury RR et al: Acritical appraisal of indications for fasciotomy after extremity vascular trauma, Arch Surg 133:547-551, 1998.
Nypaver TJ, Whyte B, Endean ED et al: Non-traumatic lower extremity acute arterial ischemia,Am J Surg 176:147-152, 1998.
Mubarek SJ, Owen C: Double-incision fasciotomy of the leg for decompression in compartment syndromes, J Bone Joint Surg Am 59:184-187, 1997.
Whitesides TE, Haney TC, Morimoto K et al: Tissue pressure measurements as a deterrminant for the need for fasciotomy, Clin Orthop 113:43-51, 1975.
Velmahos GC, Theodhorou D, Demetriades D et al: Complications and nonclosure rates of fasciotomy for trauma and related risk factors, World J Surg 21:247-253,1997
Field CK, Senkowsky J, Hollier LH et al: Fasciotomy in vascular trauma:is it to much,to often?Am Surg 60:409-411, 1994.
Finkelstein JA , hunter GA, Hu RW: Lower limb compartment syndrome: course.After delayed fasciotomy, J Trauma 40:342-344, 1996.
Cuschieri J, Anagnostopoulus P, Kralovich KA et al: Fasciotomy wound management less is better, J Trauma 125-127, 1998.
Nghiem DD, Boland JP: four-compartment fasciotomy of the lower extremity without fibulectomy: a new approach, Am Surg 46:414-417, 1980.
Ernst CB, Kaufer H: Fibulectomy-fasciotomy: an important adjunct in the management of lower extremity arterial trauma, J Trauma 11:365-380, 1971 .
Regel G, Lobenhoffer P, Grotz M et al. Treatment results of patients with multiple trauma:an analysis of 3406 cases treated between 1972-1991 at German Level 1 Trauma Center.J Trauma 1995; 38: 70-8.
Report of the Working Party on the management of patients with major injuries. J R Coll Surg Engl Nov 1988.
Creagh TA, Broe PJ, Grace PA, Bouchier-Hayes DJ. Blunt trauma-induced upper extremity vascular injuries. J R Coll Surg Edinb 1991; 36: 158-60.
Mendelson JA. The relationship between mechanism of wounding and principles of treatment of missile wounds.J Trauma 1991; 31: 1181-202.
Coupland RM. The effects of weapons:surgical challenge and medical dilemma. J R Coll Sug Edinb 1996; 41: 65-71.
Shah PM, Ivatury RR, Babu SC et al. Is limb loss avoidable in civilian vascular injuries? Am J Surg 1987; 154: 202-5.
Frykberk ER. Advances in the diagnosis and treatment of extremity vascular trauma. Surg Clin North Am 1995; 75: 207-23.
Itani KMF, Burch JM, Spjut-Patrinely V et al. Emergency center arteriogrphy. J Trauma 1992; 32: 302-7.
Frykberg ER. Arteriogrphy of the injuried extremity: are we in proximity to answer? J Matsen FA, Winquist RA, Krugmire RB: Diagnosis and management of Trauma 1992; 32: 551-2.