compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm
2. COMPARTMENT SYNDROME
Reduced organ perfusion due to increased
intra compartment pressure.
Compartment Perfusion Pressure (CPP)
Mean Arterial Pressure (MAP)
Intra Compartmental Pressure (ICP)
CPP = MAP – ICP
3. HISTORY
Richard von Volkmann[1](1881)
Described irreversible contractures of the muscles
because of ischemic processes
Hildebrand (1906)
first to suggest that elevated tissue pressure may be
related to ischemic contracture
Murphy (1914)
First to suggest that Fasciotomy might prevent the
contracture.
Volkmann R. Die ischaemischen Muskellahmungen and Kontrakturen. Zentralbl Chir. 1881;8:801–3
4. Can occur in any enclosed space;
Upper Arm
Forearm
Hand
Thigh
Leg
Foot
Abdomen
Chest
Cranial cavity
WHERE CAN IT
OCCUR
5. CAUSES OF COMPARTMENT
SYNDROME
Fracture s and haematoma
Crush injuries
Ischemia / Reperfusion
Tight bandages
Burns Eschar
Tourniquet
6. CLINICAL FEATURES
Tense swelling
Excessive pain - pain on passive movements
Numbness -e.g. anterior compt. first toe web (deep peroneal N )
Do not look for absent distal pulse – late
24. Hand
Compartment
s
10 fascial compartments
4 dorsal interossei
3 palmar interossei
Thenar muscles
Adducto r pollicis
Hypothena r muscles
25. HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release
26. HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release
Fasciotomy of the Anterior and Posterior Compartments of the Arm
Using 1 Skin Incision. A 15-cm skin incision is made over the medial
intermuscular septum, carefully avoiding the underlying neurovascular bundle.
Using rake retractors and the electrocautery device, skin and subcutaneous
tissue flaps are raised anteriorly and posteriorly. The fascia over the
anterior compartment is then opened midway between the anterior border of
the biceps muscle and the medial intermuscular septum for the length of the
skin incision. The fascia over the posterior compartment is then opened
midway between the posterior border of the triceps muscle and the medial
intermuscular septum for the length of the skin incision.
Fasciotomy of the Anterior and Posterior Compartments of the Arm
Using 2 Skin Incisions. A 15-cm skin incision starting medial to the
bicipital sulcus is extended up the anteromedial arm to the acromion and
through the fascia to decompress the anterior compartment. A 15-cm skin
incision starting at the tip of the olecranon is extended up the posterolateral
arm and through the fascia to decompress the posterior compartment.