PURPOSE The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome. MATERIALS AND METHODS Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection. RESULTS According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection. CONCLUSION Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.
Acute compartment syndrome of the thigh, which usually occurs in the anterior compartment, is a rare condition. It can have various causes including femur fractures, vessel injury, pseudoaneurysm of the femoral or popliteal artery, and use of anticoagulant. However, there have been few reports of acute compartment syndrome of the thigh without fracture caused by blunt trauma. We report 4 cases of acute compartment syndrome of the thigh without fracture caused by blunt trauma, in which three patients were treated with fasciotomy and a Vacuum-Assisted wound Closure system and the other one had a delayed diagnosis, and eventually underwent above-knee amputation.
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A Clinical Case Study of Residual Symptoms after Decompression of Traumatic Compartment Syndrome Min Jung Ji, Seong Chul Lim, Jae Soo Kim, Hyun Jong Lee, Yun Kyu Lee The Acupuncture.2015; 32(3): 197. CrossRef
Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome Ji Yong Park, Young Chang Kim, Ji Wan Kim Journal of the Korean Fracture Society.2015; 28(4): 223. CrossRef
It has been known that early recognition and prompt decompression is critical in acute compartment syndrome with tibial fracture because inappropriate treatment lead to signincant functional disabilities.
We treated 567 cases of tibial fracture and experienced 21 cases of acute compartment syndrome between September 1988 and June 1994.
The purpose of this study is to analysis the initial degree of intracompartmental pressure and duration between the diagnosis and decompression, to evaluate the functional results and to discuss the complications.
The result obtained were as follows 1. Anterior intracompartmental pressure was ranged from 25mnHg to 81mmHg (average 43.4mmHg), and deep posterior intracompartmental pressure ranged from 19mmHg to 61mmHg (average 32.7mmHg).
2. Among the 21 cases, common peroneal neuropathy were developed in 19 cases. We experienced complete recovery in 5 cases, incomplete recovery in 13 cases and 1 case of no change. We found posterior tibial neuropathy in 8 cases, and experienced complete recovery in 2 cases, incomplete recovery in 5 cases and 1 case of no change.
3. As an complications, clawing of toe developed in 3 cases, equinovarus deformity of ankle in 2 cases, superficial wound infection, osteomyelitis and nonunion in 1 case.
4. We obtained good or excellent results in 16 cases(76.1%).
5. We thought that the most important factor to decide the prognosis seems to be duration of high level of tissue pressure and also it is neccessary early diagnosis and early treatments to obtain good results.
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Is CT Angiography a Reliable Tool for Diagnosis of Traumatic Vessel Injury in the Lower Extremities? Jong-Hyuk Park, Kwang-Bok Lee, Hyuk Park, Jun-Mo Lee Journal of the Korean Fracture Society.2012; 25(1): 26. CrossRef