Спосіб фасціотомії кістково-фасціальних футлярів при компартмент-синдромі внаслідок вогнепальних поліструктурних ушкоджень кінцівки

Abstract

SummaryRationale. Compartment syndrome (CS) of bone-fascial cases (BFC) is the mostsevere complication of gunshot or traumatic limb injuries. The only pathogeneticallydetermined method of CS treatment is fasciotomy, which is one of the elements ofprimary surgical treatment.Classical open or closed fasciotomy, which involves dissection along the axis of theskin limb with underlying tissues and fascia, reduces intramuscular pressure andimproves tissue perfusion, but may not provide a sufficient decompression effect in allcases.The aim of the study was to develop and evaluate the effectiveness of the step-bystep fasciotomy, which provides adequate decompression effect and reduces the risk ofprogression of irreversible ischemic tissue changes regardless of the severity of gunshotwounds to the limb.Results and discussion. A method of fasciotomy for CS in victims with gunshotpolystructural injuries of the limb has been developed, tested and implemented. Theproposed method is a kind of open fasciotomy, which allows to achieve maximumdecompression of the BFC due to a change in the direction of dissection of the skin withthe underlying tissues and fascia relative to the axis of the limb. A step-by-stepfasciotomy is proposed: the first step is a cross-section of both layers of the fascia of thecompromised muscle relative to the axis of the limb, the second step is a longitudinalincision of both layers of the fascia in both directions from the cross-section.The expediency of the primary cross-section is due to the fact that against thebackground of increased subfascial pressure dissection of the fascia across its lines offorce is guaranteed to lead to the dilution of its edges and clear identification ofsuperficial and deep layers of the fascia, which allows the next step to perform areliable longitudinal fascia dissection.Conclusions. The proposed method of open stepwise fasciotomy can effectivelyreduce intramuscular pressure in patients due to gunshot or traumatic injury of theextremities and reduce the risk of progression of irreversible ischemic tissue changesregardless of the severity of the lesion. The use of this method allows to reduce thenumber of repeated surgical treatment of wounds by (3.4±1.4) cases and to speed up thebed-day by (2.8±1.1) days.