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Fasciotomy of Compartment Syndrome

Compartment syndrome requires urgent fasciotomy to release pressure within fascial compartments and prevent permanent muscle and nerve damage. Key indications for fasciotomy include unequivocal clinical findings, intracompartmental pressure near or above diastolic blood pressure, or over 6 hours of limb ischemia. Fasciotomies involve long incisions over all compartments to allow decompression; complications can include altered sensation, scarring, herniation or tethering. The document outlines fasciotomy techniques and wound management for the lower leg, forearm, hand and foot.

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453 views19 pages

Fasciotomy of Compartment Syndrome

Compartment syndrome requires urgent fasciotomy to release pressure within fascial compartments and prevent permanent muscle and nerve damage. Key indications for fasciotomy include unequivocal clinical findings, intracompartmental pressure near or above diastolic blood pressure, or over 6 hours of limb ischemia. Fasciotomies involve long incisions over all compartments to allow decompression; complications can include altered sensation, scarring, herniation or tethering. The document outlines fasciotomy techniques and wound management for the lower leg, forearm, hand and foot.

Uploaded by

ansuh22
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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FASCIOTOMY OF

COMPARTMENT SYNDROME
CLINICAL FEATURES – 5P
Compartment Syndrome
Indications for Fasciotomy
•Unequivocal clinical findings
•Pressure within 15-20 mm hg of DBP
•> 6 hours of total limb ischemia
•Injury at high risk of compartment syndrome
•CONTRAINDICATION -
Missed compartment syndrome (>24-48 hrs)
Fasciotomy Principles
• Make early diagnosis
• Long extensive incisions
• Release all fascial compartments
• Preserve neurovascular structures
• Debride necrotic tissues
4 Compartments of Lower Leg
The lateral incision provides
access to the lateral and anterior compartments.
The medial incision provides
access to the superficial and deep posterior
compartments.
Fasciotomy: Lateral Leg

Intermuscular
septum

Superficial
peroneal nerve
Fasciotomy: Medial Leg

Gastroc-soleus

Flexor digitorum
longus
Compartment Syndrome
Forearm

• 3 compartments
– Mobile wad-BR,ECRL,ECRB
– Volar-Superficial and deep
flexors
– Dorsal-Extensors
– Pronator quadratus
described as a separate
compartment
COMPARTMENT SYNDROME OF
THE FOREARM AND HAND

The volar incison allows


decompression of the anterior
compartment and may be carried down
to the carpal tunnel
or up onto the arm.
The dorsal incision
decompresses the posterior
compartment of the forearm and can
be used to decompress
the hand.
Compartment Syndrome
Hand

• 10 separate osteofascial
compartments
– dorsal interossei (4)
– palmar interossei (3)
– thenar and
hypothenar (2)
– adductor pollicis (1)
Compartment Syndrome
Foot
4 Compartments:
1. Interosseous or Intrinsic compartment
– 4 intrinsic muscles between the 1st & 5th
metatarsals
2. Medial compartment
– abductor hallicus and the flexor hallicus brevis
3. Central or calcaneal compartment
– flexor digitorum brevis, quadratus
plantae, and the adductor hallicus
4. Lateral compartment
– Contains flexor digiti minimi brevis
and abductor digiti minimi
Dorsal incisions
placed over 1st
and 3rd web
space allows
access and
decompression
of all
compartments
and allows easier
approach to
medial & central
compartments.
COMPARTMENT SYNDROME
THIGH

3 Compartments
Vastus lateralis

Lateral septum
Wound Management
• After the fasciotomy, a bulky compression dressing and a
splint are applied.
• “VAC” (Vacuum Assisted Closure) can be used
• Foot should be placed in neutral to prevent equinus
contracture.
• KIV SSG after three to five days
• Goal is to obtain definitive coverage within 7-10 days
Complications Related to
Fasciotomies
• Altered sensation within the margins of the wound (77%)
• Dry, scaly skin (40%)
• Pruritus (33%)
• Discolored wounds (30%)
• Swollen limbs (25%)
• Tethered scars (26%)
• Recurrent ulceration (13%)
• Muscle herniation (13%)
• Pain related to the wound (10%)
• Tethered tendons (7%)

Fitzgerald, McQueen Br J Plast Surg 2000

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