Compartment syndrome
Definition
An elevation in the interstitial pressure in a closed osseofibrous compartment that results in microvascular compromise.
Initial management of compartment syndrome
Splitting all circumferential bandages & casts can ↓ compartment pressures by more than 50%.
The optimal position for the limb is at heart level; this maximizes the arteriovenous gradient. Elevation above the heart decreases arterial inflow without altering venous outflow significantly.
Fasciotomy for acute compartment syndrome of the thigh.
Prep from iliac crest to knee.
Make lateral incision from the trochanteric line to the knee lateral epicondyle. Incise the ITB in the line of the incision. Reflect vastus lateralis off the lateral intermuscular septum, & then divide the lateral intermuscular septum over the length of the wound.
The pressure in the adductor compartment is then measured, & if elevated, it is released by a medial incision.
Fasciotomy for the leg (Double incision technique of Mubarak)
Lateral incision 5-20 cm long, 2cm anterior to the fibula. Identify the SPN. Release the anterior & peroneal compartments through this incision.
Medial incision 2cm posterior to the tibia, expose the deep & superficial posterior compartments & release these. Make sure the fascia over tibialis posterior is released.
Splint the foot in a plantigrade position.
Fasciotomy timing
Fasciotomy is probably contraindicated if more than 3-4 days have gone by, as severe infection has been reported in patients who have their necrotic muscle exposed in this fashion.