Compartment syndrome

Question 1

What is compartment syndrome?

What pressure values are indicative of CS?

Answer 1

Acute compartment syndrome of a limb is due to raised pressure within a closed fascial compartment causing local tissue ischaemia and hypoxia

• absolute compartment pressure > 40mmHg
• less than 30mmHg difference between the diastolic pressure and the compartment pressure

Question 2

Describe how you would do lower limb fasciotomies?

Answer 2

• sandbag under ipsilateral buttock

Lateral incision
- skin incision - bwn tibial crest and fibula
- DANGER - superficial peroneal nerve - 10 cm prox to lateral malleolar
- lateral intermuscular septum
- incise fascia - ensure no tight bands
- check muscle - colour, consistency, bleeding and contractility

**Medial incision **
- remove sandbag
- skin incision - posterior to medial border of tibia - 7cm skin bridge
- PROTECT - stay anterior to tib post to protect perforating vessels (5/10/15cm), long saphenous vein and saphenous nerve
- release sup post compartment fascia
- retract - expose fascia over (FDL)deep post compartment

wounds left open and negative pressure dressing

AFTER CARE
- check in 48hrs with plastics
- if can’t close recheck in further 48hrs with plastics and split skin graft if needed
- IV abx until closed

Question 3

What do the BOAST guidelines say about management of CS

Answer 3

• documentation - injury, procedure, time, response to analgesia
• monitor within 30 mins
• compartment pressure monitoring if unsure or obtunded patients
• surgery within 1hr of making the decision
• decompression of all compartments
• lower leg fasciotomies - 2 incisions - 4 compartments
• no consensus of foot compartment syndrome
• delayed presentation or diagnosis > 12hrs - greater risk with surgery - 2 consultant decision - non op is an option

Question 4

management of delayed presentation

Answer 4

• little evidence to guide treatment
• BOAST - 2 consultant decision and can consider non-op

treatment options
- less severe muscle necrosis - fasciotomies to prevent further muscle loss and to debride necrotic tissue
- complete muscle necrosis - non-op as surgery exposes risk of wound problem
- Rhabdomyolysis, systemic upset and renal failure - life saving surgery;
1. fasciotomies
2. debridement
3. amputation