3. 1881: Richard Von Volkmann, Contractura postraumatica
de la Extremidad lo atribuye a isquemia del musculo
esqueletico.
1926: Jepson, Incremento de presion compartimental
desarrolla isquemia muscular y descompresion temprana
previene contractura.
1940: Segunda Guerra Mundial y Vietnam (Norman
Rich), Fasciotomia en Campo de Batalla.
SINDROME COMPARTIMENTAL
HISTORIA
4. SĆndrome Compartimental (SC) (Compartment Syndrome): ElevaciĆ³n de la
presiĆ³n intersticial, por arriba de la presiĆ³n de perfusiĆ³n capilar dentro de un
compartimento osteofacial cerrado, con compromiso del flujo sanguĆneo en
mĆŗsculo y nervio, lo que condiciona daƱo tisular.
SINDROME COMPARTIMENTAL
DEFINICION
5. SINDROME COMPARTIMENTAL
ETIOLOGIA
DisminuciĆ³n en el tamaƱo del compartimento
CompresiĆ³n o constricciĆ³n externa
PantalĆ³n
militar
antichoque
(MAST).
Vendaje
circunferencial
Escara por
quemadura o
congelacion
Cierre
quirĆŗrgico de
defectos
fasciales
Uso
prolongado de
torniquete
18. Contractura Isquemica de Volkmann:
Necrosis de musculos isquemicos.
SINDROME COMPARTIMENTAL
COMPLICACIONES
19. Treatment for crush syndrome of extremities with antioxidants
Zhongguo Gu Shang. 2008 Feb;21(2):109-10. PMID: 19105470 [PubMed - in process]
Department of Orthopaedics, Coal General Hospital of Henan Province, Zhengzhou
450002, Henan, China.
OBJECTIVE: To study the clinical therapeutic effect of antioxidants assistant
treatment of extremities crush syndrome (CS)in order to find new therapy.
METHODS: Twenty-one male patients (aged from 24 to 48 years, mean 36 years)
were treated with the next antioxidants in early stage: (1) 20% Mannitol 250 ml
intravenous drip in 30 minutes (one time per 6 to 8 h). (2) Sodium aescinate 20
mg, Salvia Miltiorrhiza 20 ml were dissolved respectively in isotonic saline or 5%
glucose 200 ml and dripped by intravenous drip (50 to 60 drips per minute). The
drugs were used for 5 to 7 days (one time per day). Basifying urine, keeping the
negative liquid balance and electrolyte balance, preventing infection and hold out
treatment were done. When the pressure of muscular osteofascial compartment was
more than 30 mmHg, deep fasia was cut to decompress timely and the above-
mentioned drugs were continuously applied for patients. RESULTS: Myoglobin urine
of 21 cases died out after 2 to 3 days, of them, 13 cases were performed to
decompress. After open decompression, 2 cases suffered from amputation because
of long time of ischemia, 2 cases took place slight dysfunction of lower limbs, one
hand had ischemia muscular contracture in 1 case and one foot down-vertical in 1
case. After followed-up of 8 months to 1 year, according to the function standard,
the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 4
cases. The excellent and good rate was about 71.4% (15/21). CONCLUSION: After
extremities crushed for long time, application of antioxidents as early as possible
can decrease significantly the incidence and invalidity rate of CS.
Tratamiento de sindrome aplastamiento con antioxidantes.
21 masc, 1. manitol 20%, 2. eoscinato sodico, 5 a 7 dias OD.
30mmhg fasciotomia. Resultados: mioglobina disminuye en 2 a 3
dias. Conclusion: El uso de antioxidantes en etapas
tempranas disminuye la contractura postisquemica.
20. Compartment syndrome of the leg in the coagulopathic, end-stage liver disease patient:
Fasciotomy is not the best answer.
Int J Surg. 2008 Dec;6(6):e31-3. Epub 2006 Nov 1. PMID: 19059130 [PubMed - in
process]. Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles,
CA, USA.
BACKGROUND: Compartment syndrome of the leg secondary to spontaneous
bleeding has been described in coagulopathic patients. Correction of the
coagulopathy and emergency fasciotomy is the recommended treatment. We
present a cirrhotic patient with a short life expectancy who developed compartment
syndrome of the leg secondary to spontaneous bleeding. This patient underwent
fasciotomy of the leg and subsequently developed persistent postoperative bleeding
and required repeated transfusions of blood and blood products. The patient
eventually expired in the hospital 1 month after surgery. RESULTS: Compartment
syndrome of the leg occurring in patients with coagulopathy secondary to cirrhosis
is very difficult to manage. Coagulopathy in these patients is hard to correct and
constant bleeding from fasciotomy site is a major complication mandating frequent
transfusions of blood and blood products. The complications of fasciotomy in these
patients may outweigh the complications of untreated fasciotomy, particularly in
patients with a short life expectancy. CONCLUSIONS: Fasciotomy is not always the
best treatment for compartment syndrome of the leg. In certain patients,
particularly in the coagulopathic, end-stage cirrhotic patient with a short life
expectancy who is not a candidate for liver transplantation, fasciotomy is not
indicated. Fasciotomy should be used selectively, if at all, in patient population with
end-stage and terminal diseases.
SC en pac con coagulopatĆa por enfemedad teminal hepĆ”tica, la
Fasc no es la mejor respuesta. Corregir cuagulopatia y fasc de
emergencia es el trat recomendado. Pac cirrosis hepatica terminal
desarrolla SC por sangramiento espontaneo. Se realiza fasc y requiere
post mĆŗltiples transfusiones. Pac fallece al mes de cirugia.
Resultados: fasc en estos pac sobrepesan las complic de no
realizar fasc.
21. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia
on diagnosis.
Br J Anaesth. 2009 Jan;102(1):3-11. Epub 2008 Nov 19. PMID: 19022795 [PubMed -
indexed for MEDLINE]. Department of Anaesthesia, St Vincent's Hospital, Melbourne,
PO Box 2900, Fitzroy, 3065 VIC, Australia. gjpmar@yahoo.com.au
Acute compartment syndrome can cause significant disability if not treated early,
but the diagnosis is challenging. This systematic review examines whether modern
acute pain management techniques contribute to delayed diagnosis. A total of 28
case reports and case series were identified which referred to the influence of
analgesic technique on the diagnosis of compartment syndrome, of which 23
discussed epidural analgesia. In 32 of 35 patients, classic signs and symptoms of
compartment syndrome were present in the presence of epidural analgesia,
including 18 patients with documented breakthrough pain. There were no
randomized controlled trials or outcome-based comparative trials available to
include in the review. Pain is often described as the cardinal symptom of
compartment syndrome, but many authors consider it unreliable. Physical
examination is also unreliable for diagnosis. There is no convincing evidence that
patient-controlled analgesia opioids or regional analgesia delay the diagnosis of
compartment syndrome provided patients are adequately monitored. Regardless of
the type of analgesia used, a high index of clinical suspicion, ongoing assessment of
patients, and compartment pressure measurement are essential for early diagnosis.
SCA en pierna y el efecto de analgesia postoperatoria en el
diagnostico. Pac bajo analgesia epidural se diagnostica un SC con
examen clinico no siendo el dolor el sintoma principal. Realizando
un buen ex. Clinico y teniendo presente la sospecha de un SC y
midiendo la presion compartimental se diagnostica SCA
Tratamiento de sindrome aplastamiento con antioxidantes. 21 masc, 1. manitol 20%, 2. eoscinato sodico, 5 a 7 dias OD. 30mmhg fasciotomia. Resultados: mioglobina disminuye en 2 a 3 dias. El uso de antioxidantes en etapas tempranas disminuye la contractura postisquemica
SC en pac con coagulopatia enfemedad teminal hepatica, Fasc no es la mejor respuesta. Correcion de cuagulopatia y fasc de emergencia es el trat recomendado. Pac cirrosis hepatica terminal desarrolla SC por sangramiento espontaneo. Se realiza fasc y requiere post multiples transfusiones. Pac fallece al mes de cirugia. Resultados: fasc en estos pac sobrepesan las complic de no realizar fasc.
SCA en pierna y el efecto de analgesia postoperatoria en el diagnostico. Pac bajo analgesia epidural se diagnostica un SC con examen clinico no siendo el dolor el sintoma principal. Realizando un buen ex. Clinico y teniendo presente la sospecha de un SC y midiendo la presion compartimental se diagnostica SCA
Patologia y Opcion diagnostica de SC en piernas. Objetivo: evaluar progresion de SC midiendo presion intracompartimental y monitoreo de disminucion de oxigenacion tisular, indicando microcirculacion deficiente secundaria. 16 pac revascularizacion (2 dia PO). Resultados: 12 casos ICP >40mmhg ā StO2 50 ā 53% se realiza fasciotomia. 4 casos ICP 25 ā 35 mmhg ā StO2 normal. Conclusion: el uso de ICP y medida de saturacion ayuda a la decision quirurgica.