Early Fasciotomy Research Articles

The natural history following venous ligation for civilian injuries.

Contrary to prevailing views, documentation of major morbidity after venous ligation for trauma is sparse. Forty-six patients had ligation for injury to the major veins of the lower extremities, namely, vena cava (six), external iliac (five), common iliac (three), common femoral (eight), profunda femoris (six), superficial femoral (thirteen), and popliteal (five). The post-ligation management included: 1) early and extensive fasciotomy when indicated, 2) initial strict bed rest with elevation until edema free, 3) trial ambulation for 2 hours, 4) added elevation if trial ambulation leads to recurrent edema. Forty patients were discharged edema free, and six patients had mild edema. Followup examination in 39 patients revealed no edema in 30 patients, mild edema requiring no treatment in one patient, and moderate edema requiring support hose in eight patients. No severe or massive edema causing ulceration or ischemia occurred. Based on these findings, primary venous interruption is a safe, quick and effective means of managing venous injury whenever the extent of injury or the severity of associated injuries make primary repair hazardous.

Compartment syndromes of the forearm: Early recognition using tissue pressure measurements

A compartment syndrome of the forearm can be a devastating injury if not relieved promptly by early fasciotomy. Of five patients who developed compartment syndromes, compartment pressures were measured in four and found to average 69 mm Hg. Tissue pressure measurements provided early objective evidence of the presence of the compartment syndrome and contributed significantly to the ultimate functional recovery. We would advise repeating the measurement for pressures in excess of 30 mm Hg in the upper extremity, and fasciotomy for pressures in excess of 40 mm Hg when accompanied by any neurovascular compromise.

The natural history of electrical injury.

The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x=11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS-8, peripheral-8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits-17, hand-1, foot-2, leg-3, arm-9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.

Compartmental syndromes following trauma.

When an ischemic contracture develops after injury it appears that the ischemia has pursued a middle course between full recovery and gangrene. The mechanism of such a pathology is difficult to understand. There appear to be two distinct types of injury that precipitate such a contracture; one where a major vessel is occluded and the ischemic tissue lies distal to the injury; and a second where the injury is a direct one and the ischemia develops at the site of the injury. The ischemic changes that develop after both types of injury appear to be remarkably similar and they develop, almost exclusively, where the tissues involved lie within unyielding osteofascial compartment. In both types, compartmental syndrome could have been precipitated; on the one hand by the ischemia of arterial interruption and on the other by direct tissue damage. Early fasciotomy is advocated after both types of injury, quite apart from any necessary arterial repair.

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.

Traumatic tension ischaemia in muscles

Summary The pathogenesis of ischaemia of leg muscles after trauma is discussed. An experiment on an amputated leg showed that increasing the interstitial pressure significantly reduces the blood flow to the muscles. It is suggested that early fasciotomy in the appropriate case will reduce the pressure in a leg compartment and save affected muscles.

Volkmann's Ischemic Contracture After Intra-Arterial Injection of Secobarbital

A clinical syndrome follows accidental self-administration of secobarbital intra-arterially. It is characterized by immediate, severe, burning pain radiating into the hand. Tense muscle edema and necrosis developed during 24 to 48 hours in the presence of an intact radial pulse. Confusion with cellulitis may delay accurate diagnosis. Early fasciotomy can prevent the development of Volkmann's ischemic contracture.

Peroneal compartment syndrome

1. A case of ischaemic necrosis of the peroneal muscles (peroneal compartment syndrome) is described. Recovery or regeneration of a seemingly necrotic peroneus brevis was noted.2. The similarity between peroneal compartment syndrome and the anterior tibial syndrome is noted.3. Treatment by early fasciotomy is advised.

Early fasciotomy in the treatment of anterior tibial syndrome

Early fasciotomy in the treatment of anterior tibial syndrome