Simulation education for lower limb fasciotomy: improving surgical trainee confidence in executing a time-critical limb-saving procedure.

Abstract

Acute extremity compartment syndrome is a relatively rare but well-recognised complication seen in a wide variety of clinical situations from acute trauma to snakebites. Local swelling within a muscle compartment results in increasing tissue pressure resulting in critical ischaemia, severe pain and altered sensation. There is only one effective treatment and that is timely surgical decompression of the osteofascial compartments involved.1 Failure to do so results in crippling ischaemic muscle contractures and in extreme cases, death. The surgical treatment is technically simple, however the stumbling blocks to success lie in recognition along with the speed and completeness of the surgery. Each of the four osteofascial compartments in the leg (anterior, peroneal, deep and superficial posterior) must be fully decompressed.1 The development of the Management of Surgical Emergencies (MSE) course was supported by the Department for International Development with the International Federation of Surgical Colleges, Association of Surgeons of Great Britain and Ireland, and College of Surgeons of East, Central and Southern Africa.2 Following an initial pilot course, the need for integration of compartment syndrome education was identified by one of the authors (YN). In Africa, although a huge proportion of the clinical workload is obstetrics and general surgery, a surgeon is expected to deal with all conditions requiring surgery. There are parallels between this truly time-critical emergency and cardiac arrest for which simulation training is well established, as it is …