Compartment Syndrome Of Upper Limb Research Articles

Closure of Fasciotomy Wound Using Dynamic Dermal Approximation Technique

Purpose: Compartment syndrome is a surgical emergency that is managed by a fasciotomy. However, it is associated with complications, including long hospital stay, wound infection and osteomyelitis need for further surgery for delayed wound closure or skin grafting, scarring, delayed bone healing, pain and nerve injury, permanent muscle weakness, chronic venous insufficiency, cosmetic problems, and an overall increased cost of care. A need for an early closure technique that will decrease all the above complications is described in this study. Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between from January 2020 to December 2022.This hospital-based study was done on compartment syndrome patients where fasciotomy was done and the wound closed by dynamic dermal suture approximation technique and results reviewed and outcome assessed. Results: The technique was applied to a total of 12 patients with compartment syndrome. Ten of twelve patients in study were compartment syndrome of upper limb since severe lower limb trauma patients were excluded in view of need for other procedures. The wounds were divided into three classes as post burn, post trauma and post contrast extravasation. Wound closure was achieved in 75 percent of total cases and all of six post contrast extravasation compartment syndrome patients. Conclusion: Following a fasciotomy, wound closure is a topic that is often controversial. The preference for one technique over another is influenced by the availability of resources, institutional familiarity, and clinical scenarios. Dynamic dermal approximation sutures can be applied with minimal risk to most uncomplicated fasciotomies. The benefits are minimal complication, the best cosmetic outcome, and low cost. However, patients with a high risk of complications may need other methods. Keywords: Compartment Syndrome, Fasciotomy, Wound Closure Techniques, Negative-Pressure Wound closure

Continuous stellate ganglion block for the effective management of ischemic pain following compartment syndrome of upper limb due to accidental intra-arterial injection

In the present era of advanced medicine and patient safe practice, accidental intra-arterial injection of drugs is a rare occurrence. Compartment syndrome (CS) is one of its most detrimental complications, which leads to loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. Rapid recognition and emergent fasciotomy to relieve the compartment pressure are imperative to prevent irreversible damage. Sympathetic blockade is one of the most common interventions used in the management of early stages of CS, which interferes with the pain cycle and improves distal flow by vasodilatation. We report a complicated case of CS of the right upper limb following accidental intra-arterial injection. The patient suffered with persistent ischemic pain despite surgical decompression, which was successfully managed by continuous stellate ganglion block.

A Case of Acute Compartment Syndrome of Upper Limb in a Dengue Haemorrhagic Fever Patient Secondary to Intravenous Cannula Insertion

Dengue fever with its haemorrhagic complications is a common viral illness in Malaysia which can sometimes lead to high morbidity and mortality. We present a case report of a 27-year-old male who was admitted to our hospital with dengue haemorrhagic fever. He developed multiple hematomas and bruising in his right forearm and arm due to intravenous cannula insertion. Due to coexisting thrombocytopenia, the limb progressed to acute compartment syndrome and emergency fasciotomy was done and his limb was salvaged. This case illustrates an important potential complication of dengue fever and the importance of timing of surgery in the event of compartment syndrome.

Acute compartment syndrome of upper limb as an unusual complication of dengue hemorrhagic fever

Dear Editor, Dengue fever with its hemorrhagic complications is a common viral illness in India and other south Asian countries. We present a case of dengue hemorrhagic fever associated with capillary leak syndrome presenting as a compartment syndrome involving the right upper limb in the background of iron deficiency, which we believe to be the first such presentation of dengue in medical literature. Our patient, a 40-year-old man, presented with high grade continuous fever, retro-orbital headache, and generalized body ache for 5 days along with scanty gum bleeding for 2 days. He also had red spots and swelling of the right forearm for 2 days, the swelling being gradual in onset, painful, reddish in appearance, and rapidly progressing to restrict movements of the right upper limb. There was no history of trauma, insect bites, rash, drug reaction, or past history suggestive of any coagulation disorder. On examination, the patient was febrile, conscious, oriented, had mild pallor, and active gum bleeding in the oral mucosa. There was a warm, tense, tender, erythematous swelling involving the entire right forearm, wrist, hand, and all fingers, with hypoaesthesia involving all sensory modalities but without any ulceration or discharge. Both active and passive movements at all joints involving the right hand and wrist were severely painfully restricted and resisted. Laboratory tests revealed hemoglobin (Hb) 7.2 g/dL, platelets 15,000/μL and Hematocrit 58%, and erythrocyte sedimentation rate (ESR) of 36 mm in first hour. Abnormal cells or parasites were absent on the peripheral smear. Biochemical tests including liver function test (LFT), kidney function test (KFT), electrolytes and urine routine, and microscopic examination (RE/ME) were all normal. Malarial antigen tests were repeatedly negative. Dengue IgG and IgM were strongly positive and an initial diagnosis of dengue hemorrhagic fever was entertained. Disseminated intravascular coagulation (DIC) was ruled out with a normal serum level of fibrin degradation products (8.2 μg/dL). Platelet transfusion support, fluids, and paracetamol were instituted. Chest X-ray, X-rays of the right arm, forearm, and hand were all normal. Ultrasonic (USG) Doppler of the right forearm documented gross soft tissue swelling with no compromise of the venous or arterial blood flow. Orthopedic consultation concurred with our diagnosis of right forearm compartment syndrome with Volkmann's Ischemic contracture (VIC) grade III. Despite low platelets, high risk surgical decompression of the right forearm was performed after 2 days with blood component support, and extensive muscle swelling discoloration was demonstrated during operation. Large clots were removed from the anterior compartment and the muscles began to regain their natural color immediately following fasciotomy. Post-operative recovery was uneventful over the next 12 days [Figure 1], without any fever, secondary infection, or swelling on any other site of the body. Hb and platelet counts subsequently rose to 8.6 g/dL and 1,10,000/μL, respectively. Secondary closure of right forearm fasciotomy was done at 2 week follow-up. Figure 1 Photograph of the right forearm 3 days after emergency fasciotomy. The edematous muscles of the anterior compartment of the right forearm are visibl As documented in the literature, the cardinal feature of dengue hemorrhagic fever (DHF) results from a transient increase in vascular permeability that causes fluid leakage from the intravascular to the interstitial compartment, leading to hemoconcentration, and circulatory collapse, which contribute to mortality and significant morbidity.[1] Capillary leak syndrome is seen in various situations, sepsis and dengue being the major infectious causes.[2] The mechanisms of capillary leak may involve increased hydrostatic pressure, decreased oncotic pressure, or increased permeability of the capillary endothelium.[3] Among the other infectious causes of capillary leak leading to compartment syndrome, Brucellosis, Hantavirus infection, and sepsis have been mentioned in literature.[4] Idiopathic systemic capillary leak syndrome (SCLS) or Clarkson's disease is another important cause of capillary leakage, where there are recurrent episodes of hypovolemic shock, edema, hemoconcentration, and hypoalbuminemia. Episodes of systemic capillary hyperpermeability due to various cytokines have been implicated in the pathogenesis of this disorder.[5,6] The most common bleeding manifestations of dengue include petechiae, gum bleeding, GI bleeding and hemoptysis although rarer sites are often involved.[7] Even after thorough clinical and radiological evaluation (chest skiagram and abdominal ultrasound), we did not find evidence of capillary leakage at the common sites like pleural cavity, pericardial cavity, and peritoneum. Workers from South India have shown that bleeding in dengue might lead to abdominal compartment syndrome in rare cases.[8] The solitary involvement of the right forearm in this scenario is indeed uncommon, and adds to the clinical interest of this case. In conclusion, internists must be aware of these different forms of dengue complications, where urgent and aggressive interventions may enable physicians to salvage limbs and prevent mortality. We report this case to underline the importance of internal bleeding and capillary leak in dengue, as also to record a clinical scenario as yet unreported in the world literature.