Decompression Fasciotomy Research Articles

Compartment Syndrome and Its Validation in Skeletal Injuries

Background Compartment syndrome, a potential limb-threatening condition in acute traumatic situations following different modalities of injury, may lead to irreversible damage or even life risk later. Its differential time-bound clinical presentation with added observer bias on available invasive and noninvasive diagnostic modalities influences the decision-making and undue delay for early intervention toward limb salvage procedure. Results Thirty-two patients were included in our study with mean age of 36; males (18; 56.3%) were more injured than females (14; 43.8%) and left limb (17; 53.1%) was more involved than right (15; 46.9%). Mean calf muscle measurement of total injured limb with relation to immediate time was 39.9 cm, after 1 hour was 40.69 cm, after 2 hours was 41.06 cm, and after 3 hours was 41.40 cm; 95% confidence interval was found to be statistically significant. Three patients (9%) underwent emergency decompression fasciotomy, with an average mean of 41.4 cm for injured limbs against 38.5 cm in control limb. Conclusions Compartment syndrome is an acute emergency with potential irreversible damage when undiagnosed. Bias on diagnosis evolves around observer skills and clinical invasive and noninvasive methods, with differential statistical results pertaining to its decision-making for emergency fasciotomy.

Compartment syndrome following a jellyfish sting: a case report

BackgroundWhile the majority of reported cases of jellyfish envenomation are self-limited with few lasting complications, a few can cause life-threatening and debilitating illnesses. We present the case of a 15-year-old male who had an unusual presentation of a jellyfish sting that led to acute compartment syndrome.Case presentationA 15-year-old Lebanese (Arab) boy was stung by a jellyfish, which led to acute compartment syndrome in the left arm. Decompression fasciotomy and local application of diluted nitroglycerin helped to relieve the ulnar and radial artery spasms. The patient was left with shoulder and elbow pain and elbow flexion weakness, which improved after physiotherapy over a period of 6 weeks.ConclusionsCurrent therapy recommendations for acute compartment syndrome following jellyfish stings are mainly based on case reports. Urgent fasciotomy and local application of nitroglycerin have been demonstrated to be helpful in severe jellyfish stings associated with acute compartment syndrome.

The surgical correction of refractory venous trophic ulcers

Objectives. To study the effectiveness of layered dermatolipectomy and endoscopic fasciotomy in the surgical treatment of refractory venous trophic ulcers.Materials and methods. Patients (n = 105) of the C6 clinical class underwent crossectomy and short stripping. In group I (n = 35), free autodermoplasty of trophic ulcers with a perforated flap was performed. In group II (n = 36), shave therapy and autodermoplasty were performed. In group IIІ (n = 34), fasciotomy, shave therapy and autodermoplasty were performed. Long-term results of treatment were studied in the period from 1 to 12 months.Results. Complete healing of venous trophic ulcers was observed in group I at 49,4 ± 7,2, in II – at 31,4 ± 4,7, in III – at 32,1 ± 3,6 days сутки (t1-2 = 2,09; p1-2 = 0,049; t1-3 = 2,24; p1-3 = 0,024; t2-3 = 0,03; p2-3 = 0,763). Full engraftment of an autograft graft was recorded in 7 (19,4 %) patients of group I, in 27 (77,1 %) cases in group II and in 27 (79,4 %) patients of comparison group III (χ21-2 = 23,674; p1-2 = 0,001; χ21-3 = 25,173; p1-3 = χ22-3 = 0,052; p2-3 = 0,826).Conclusion. Layered dermatolipectomy with autodermoplasty and endoscopic decompression fasciotomy is an effective method for the treatment of persistent refractory venous trophic ulcers.

Complications of Muscle Hematomas in Hemophilia.

Prevention is essential for avoiding the complications of muscle hematomas (compartment syndrome, pseudotumors and peripheral nerve lesions) in hemophilic patients. This is achieved through early diagnosis of muscle hematomas and proper long-term hematological treatment until they have resolved (confirmed by image studies). Ultrasound-guided percutaneous drainage could be beneficial in terms of achieving better and faster symptom relief. Acute compartment syndrome (ACS) requires emergency surgical treatment (decompression fasciotomy). As for pseudotumors, the biopsy will help us confirm the diagnosis and rule out true tumors (chondrosarcoma, liposarcoma, synovial sarcoma) that sometimes mimic hemophilic pseudotumors. Surgical removal of hemophilic pseudotumors is the best solution. As alternatives, there are curettage and filling with cancellous bone and radiotherapy (when surgery is contraindicated). Preoperative arterial embolization (ideally 2 weeks before surgery) helps control intraoperative bleeding during surgery for giant pelvic pseudotumors. Peripheral nerve injuries, which are rare, almost always occur due to compression of hematomas in the vicinity. In most cases, they usually resolve with hematological treatment only. If such treatment fails, surgery would be indicated.

Shoe lace technique, a simple and less expensive method for Fasciotomy wound closure following compartment syndrome

Introduction: Compartment syndrome is a common and severe medical condition that can lead to ischemia and ultimately tissue loss. The treatment of choice is emergent fasciotomy to lower the compartment pressure. However, closing fasciotomy wound often presents a problem because of edema and skin retraction. As a result, numerous techniques have been devised to optimize wound closure. AIM: To perform fasciotomy wound closure by shoe lace technique which is a type of dermal apposition technique for gradual primary closure of fasciotomy wound. Materials and Methods: The study included 19 patients who presented with compartment syndrome involving either upper or lower extremities due to various causes. Decompression fasciotomy was performed in all the cases to relieve compartment pressure. Shoe lace technique was performed for closure of wound. Patients demographics, location of fasciotomy, time duration between injury and fasciotomy, number of tightening session, time to primary closure, length of hospital stay, need for skin grafts and any complication if occurred during procedure were recorded. Results: Out of 19 patients 15 were males and 4 were females. Average age was 34.8 years. Lower extremity was involved in 14 cases. Fracture was the cause of compartment syndrome in 16 cases. Closure was obtained at an average of 3.5 tightening session. All the fasciotomy wounds were closed within an average of 8.3 days. Average duration of hospital stay was 12.3 days. No major complication was encountered in the study one case reported to have infection at wound site. Conclusion: Shoe lace technique is a simple and economical method for fasciotomy wound closure. It takes less time to closure, does not need a second procedure for closure thus reduces need of nursing care, hospital stay resulting in lower morbidity, healthcare cost and better aesthetic result.

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital.

Background:Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy.Methods:Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted.Results:One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work.Conclusion:Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

Is sports a pain in the leg? Isolated peroneal compartment syndrome: Case report and literature review

Compartment syndrome of the leg in sports is often due to repetitive strenuous activity and is relieved with rest. The anterior compartment is the most commonly affected. We report a rare case of isolated sub acute peroneal compartment syndrome after horse riding. The diagnosis was suspected on clinical grounds and supported by intracompartmental pressure measurements, after which a decompression fasciotomy was performed. It is important that clinicians and athletes alike are aware of this condition and its risk factors to prevent the potentially catastrophic sequelae of a delayed diagnosis.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

Comparative Analysis of Detorsion Alone Versus Detorsion and Tunica Albuginea Decompression (Fasciotomy) with Tunica Vaginalis Flap Coverage in the Surgical Management of Prolonged Testicular Ischemia

Comparative Analysis of Detorsion Alone Versus Detorsion and Tunica Albuginea Decompression (Fasciotomy) with Tunica Vaginalis Flap Coverage in the Surgical Management of Prolonged Testicular Ischemia

Comparative Analysis of Detorsion Alone Versus Detorsion and Tunica Albuginea Decompression (Fasciotomy) with Tunica Vaginalis Flap Coverage in the Surgical Management of Prolonged Testicular Ischemia

Recent data suggest that testicular torsion may include an element of the compartment syndrome that improves with decompression. In 2009 we instituted tunica albuginea incision with tunica vaginalis flap coverage as an alternative in cases in which the torsed testis continued to appear ischemic after detorsion. The medical records of 65 boys who underwent scrotal exploration for testicular torsion between 2000 and 2010 were reviewed. There were 6 patients excluded from study due to lack of followup. Of the remaining 59 patients 31 (52.5%) showed improvement in testicular appearance after detorsion and underwent orchiopexy, whereas 28 (47.5%) did not show evidence of recovery after detorsion. Of these patients 11 underwent tunica albuginea incision with tunica vaginalis flap coverage and 17 underwent orchiectomy. Demographic data, duration of symptoms and rate of testicular salvage were analyzed. Mean patient age was 11.8 years (detorsion plus orchiopexy), 10.1 years (tunica albuginea incision plus tunica vaginalis flap coverage) and 10.1 years (detorsion plus orchiectomy). Average followup was greater than 6 months in all groups. Mean duration of torsion was 13.4 hours (detorsion plus orchiopexy), 31.2 hours (tunica albuginea incision plus tunica vaginalis flap coverage) and 67.5 hours (detorsion plus orchiectomy). Before tunica albuginea incision with tunica vaginalis flap coverage was offered, the rate of orchiectomy was 35.9% (14 of 39) vs 15% (3 of 20) after this technique was introduced (p <0.05). The rates of testicular salvage were 62.5% (detorsion plus orchiopexy), 54.6% (tunica albuginea incision plus tunica vaginalis flap coverage) and 0% (detorsion plus orchiectomy). Although the numbers are limited, it is likely that without tunica albuginea incision with tunica vaginalis flap coverage 6 of 11 testes would have been removed. This preliminary experience suggests that tunica albuginea incision with tunica vaginalis flap coverage is a promising option for the management of clinically marginal torsed testes, enhancing salvageability after prolonged ischemia. We recommend considering this maneuver before performing orchiectomy in selected cases of testicular torsion.

A Conservative Approach to Testicular Rupture in Adolescent Boys

Management for blunt trauma with breach of the renal capsule or bladder (extraperitoneal) has largely become nonsurgical since a conservative approach proved to be effective and safe. Currently the recommendation for managing testicular rupture is surgical exploration and débridement or orchiectomy. We report outcomes in boys diagnosed with testicular rupture and treated without surgical intervention. In the last year we conservatively treated 7 consecutive boys with delayed presentation of testicular rupture after blunt scrotal trauma. Patients were treated with scrotal support, antibiotics to prevent abscess, rest, analgesics and serial ultrasound. We report clinical information and outcomes. The 7 boys were 11 to 14 years old and presented 1 to 5 days after injury. Trauma was to the left testis in 3 cases and to the right testis in 4. Patients presented with mild to moderate pain and similar scrotal swelling. Ultrasound findings consistently revealed hematocele and increased echogenicity. Blood flow was present in the injured portion of the testes in 3 cases and to the remainder of the affected testicle in 6 of the 7 boys. In the remaining boy an adequate waveform was not seen in either testicle, which the radiologist thought was secondary to prepubertal status. Other findings included scrotal edema, irregular contour and seminiferous tubule extrusion. Followup was greater than 6 months in all cases. Five boys were seen at the office and the 2 remaining had telephone followup. In all cases hematocele resolved, testicular size stabilized without atrophy and echogenicity normalized in the 5 patients with followup ultrasound. One patient required surgical repair of hydrocele 4 months after trauma but no other patient needed surgical exploration. No abscess or infection developed. A conservative approach in a select group of adolescent boys with testicular rupture can result in resolution of the fracture and maintenance of testicular architectural integrity.

An unusual exit point from an electrocution injury

Injuries sustained from high voltage electrical current are well documented [1–3]. Cardiac arrest and death often ensue and survivors may have extensive damage to soft tissue and bone along with muscle necrosis and rhabdomyolysis. Decompression fasciotomy or amputation may be necessary [4]. Longterm neurological complications are also widely reported [5,6]. Cutaneous burns can occur at the entry and exit points of the path taken by the current. We present a case of a 19-year-old man who sustained a high voltage electrical injury causing cardiac arrest, diffuse brain injury and burns to the hands and feet. Several weeks after the initial injury additional exit points were noted on the labial surface of his upper central incisor teeth. To our knowledge this is the first reported case of electrical exit points causing cavitation of the teeth.

Modified mini-open technique with skin transillumination for decompression fasciotomy in the treatment of chronic exertional compartment syndrome.

Fasciotomy for chronic exertional compartment syndrome can be achieved by a variety of methods, many of which involve the blind passage of scissors or a fasciotome to release the affected compartments. We describe a modified open technique of fasciotomy which provides direct visualization of the fascia and the superficial peroneal nerve, using a single small incision. This technique requires a 4-cm longitudinal incision centered at the midpoint of the fibula. Subcutaneous tissues are dissected and a fascial incision is made. Langenbach retractors are used to lift the skin from either end of the wound. A light is used to transilluminate the skin proximal and then distal to the wound, and a fasciotome is used to extend the fasciotomies for both anterior and lateral compartments. Fasciotomy using this method was carried out on 20 cadaveric legs from 10 specimens. After decompression, a fulllength skin incision was made and the subcutaneous tissues were dissected to assess adequacy of release, anatomic course of the superficial peroneal nerve and complications. Fasciotomy was completed in twenty legs for both the anterior and lateral compartments. A complete fascial release was attained for both compartments in all legs. There were no retained fascial bands or nerve injuries. Fasciotomy using this method may be a safe and reliable method for compartment decompression, and may reduce iatrogenic risk to neurovascular and muscular structures in clinical practice.

TESTICULAR MICROLITHIASIS AND ANTISPERM ANTIBODIES FOLLOWING TESTICULAR BIOPSY IN BOYS WITH CRYPTORCHIDISM

Testicular biopsy (TBx) performed during orchiopexy in boys with cryptorchidism can help to predict future semen analyses and possibly identify patients at risk for testicular cancer. It has been theorized that TBx can be detrimental to the long-term health of the testis. We examined testicular microlithiasis (TM) and antisperm antibody (ASA) production in cryptorchid TBx. A total of 112 males underwent fertility evaluation. These patients had previously undergone orchiopexy and bilateral TBx (mean age 8.6 years) for unilateral or bilateral undescended testis. At a mean age of 19.6 years all patients underwent physical examination and scrotal ultrasound for evaluation of testis size, echotexture and abnormalities. Of 112 patients 57 also underwent direct Immunobead(R) assay with positive controls. Moving sperm free and/or bound to IgG bead complex were counted in the preparation. A total of 29 patients had bilateral and 83 had unilateral undescended testis. Of the 112 patients 26 were black and 86 were white. Four black patients (15.4%) and 4 white patients (4.7%) had testicular microlithiasis. Three patients had bilateral and 5 had unilateral diffuse TM. No tunica albuginea scars or testis masses were noted. In the 57 patients who underwent direct Immunobead assay no semen sample demonstrated evidence of forming bead-sperm complex, ie none had direct ASA. No patient exhibited evidence of direct ASA. Prepubertal open TBx does not increase the rate of TM. We found no evidence of additive testicular damage associated with TBx at the time of orchiopexy.

GLUTEAL COMPARTMENT SYNDROME MISDIAGNOSED AS DEEP VEIN THROMBOSIS

SUMMARYGluteal compartment syndrome usually occurs secondary to prolonged immobility and recumbency following alcohol and drug abuse. The resultant pain and swelling in the lower limb may be misdiagnosed as deep vein thrombosis. Once compartment syndrome is diagnosed, urgent decompression fasciotomy is required. The outcome is poor if the diagnosis is missed or delayed. We report such a case.

Primary Anaplastic Large Cell Lymphoma of Skeletal Muscle Presenting with Compartment Syndrome

We describe a patient with primary anaplastic large cell lymphoma of the forearm presenting with compartment syndrome. Urgent decompression fasciotomy and combination chemotherapy resulted in durable remission status. This is followed by a review of primary skeletal muscle lymphoma in the English literature.

ACUTE COMPARTMENT SYNDROME OF THE FOREARM

The forearm is the most common site for compartment syndrome in the upper extremity. The three compartments of the forearm include the volar (anterior or flexor), the dorsal (posterior or extensor), and the mobile wad. Both-bone forearm fractures and distal radius fractures are common initial injuries in adults that lead to acute forearm compartment syndrome. Supracondylar fractures, especially those with associated vascular injuries, are frequent causes of compartment syndrome in children. The flexor digitorum profundus and flexor pollicis longus are among the most severely affected muscles because of their deep location, adjacent to bone. Initial treatment consists of removal of occlusive dressings or splitting or removal of casts. If symptoms do not resolve rapidly, fasciotomy is indicated. Decompression fasciotomy of the forearm is performed through volar or dorsal approaches. The medial nerve is decompressed throughout its course, including high-risk areas deep to the lacertus fibrosus; between the humeral and ulnar heads of the pronator teres, the proximal arch, and deep fascial surface of the flexor digitorum superficialis; and the carpal tunnel.

Early Decompression Fasciotomy in the Treatment of High-Voltage Electrical Burns of the Extremities

Based on a knowledge of electropathophysiology, a recommended treatment has been proposed for the management of extensive high-voltage electrical burns. Early, aggressive, surgical intervention consisting of adequate decompression fasciotomy and wound debridement has been emphasized as the first line of treatment. Frequent redebridements under general anesthesia are important to the preservation of viable tissue. Early coverage procedures or attempts at primary closure following decompression are contraindicated in high-voltage injuries. This method of treatment in eight cases of high-voltage, electrical injury has preserved viable tissue, decreased the incidence of fatal sepsis and renal shutdown, decreased patient morbidity, and generally facilitated patient rehabilitation.

The Medial Tibial Syndrome

The clinical feature of the anterior tibial syndrome has been well known. It's chronic type was initially reported by Mayor in 1956. It is less known that the mascles of the deep crural compartment may be affected in a similar way: only eleven cases have reported by Puranen in 1974. He called the condition caused of chronic athletic injury as the Medial Tibial Syndrome. We have made the field study of this condition among high school students and founded that main complaint of questionable cases was pain over the inner border of the tibia. The incidence of the condition was 0.07%: six cases (eight legs) in 9015 students.The pain may be so sever as to make training impossible. Clinical and laboratory examination of these cases were free. Though the pathogenesis is not perfectly understood, it seemed to us that main facters have been local ischemia and traction periostitis secondary to exercise. We experienced one cases which was operated (decompression fasciotomy as described by Puranen), and was obtained in good result. The other cases are scheduled to be followed.

SURGERY OF THE DEEP FASCIA OF THE LEG. II. DECOMPRESSION FASCIOTOMY FOR THE TREATMENT OF SWOLLEN INDURATED LEGS DUE TO DEEP VENOUS THROMBOSIS OF THE CALF.

SURGERY OF THE DEEP FASCIA OF THE LEG. II. DECOMPRESSION FASCIOTOMY FOR THE TREATMENT OF SWOLLEN INDURATED LEGS DUE TO DEEP VENOUS THROMBOSIS OF THE CALF.