Fasciotomy of leg skin#

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These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. The most reliable diagnostic test is siting an intra-compartmental pressure monitor, which may be utilised where there is clinical uncertainty, such as in atypical presentations or if the patient is unconscious / intubated (normal compartmental pressures are 0-8mm Hg)Ī creatine kinase (CK) level may aid diagnosis, if elevated (or trending upwards). Clinicians should therefore have a high degree of clinical suspicion for compartment syndrome in post-operative patients.

Figure 2 - Illustration demonstrating the pathophysiology of compartment syndromeĬompartment syndrome is a clinical diagnosis, based on the symptoms and risk factors present. Figure 1 – Cross section of the muscles of the distal forearm, highlighting those of the posterior compartment Pathophysiology Monitor renal function closely, due to the potential effects of rhabdomyolysis or reperfusion injury. If the remaining tissues are healthy, the wounds can then be closed (the subtending fascia is often left open). This is to assess for any dead tissue that needs to be debrided.

Fasciotomy of leg skin#

Once fasciotomies have been performed, the skin incisions are left open and a re-look is planned for 24-48 hours.

Treat symptomatically with opioid analgesia (usually intravenous).

Remove all dressings / splints / casts, down to the skin (no layers of any dressing must be left circumferentially).

This transiently improves perfusion of the affected limb.

Augment blood pressure with bolus of intravenous crystalloid fluids.

Improve oxygen delivery with high flow oxygen.

Keep the limb at a neutral level with the patient (do not elevate or lower).

Prior to definitive intervention, additional management steps should include: The most important part of the management is early recognition and immediate surgical treatment via urgent fasciotomies (Fig. If the disease progresses, the features are acute limb ischaemia will subsequently develop (often referred to as the ‘5 P’s’): Pain (disproportionate to the injury), Pallor (or mottled, which becomes non-blanching), Perishingly cold, Paralysis, and Pulselessness. The affected compartment may feel tense (compared to the contralateral side), but will not generally be swollen (as the fascial compartment is only minimally distensible). Parasthesia can occur, however whilst the patient may have had a neuropraxia at the time of the injury, it is the presence of evolving neurology that is most important. The pain is made worse by passively stretching the muscle bellies traversing the affected fascial compartment. The most reliable symptom of compartment syndrome is severe pain, disproportionate to the injury, which is not readily improved with initial measures (such as analgesia, elevation to the level of the heart, and splitting a tight cast). Symptoms tend to present within hours, although it can develop up to 48 hours post-insult. Paraesthesia is therefore a common symptom.Īs the intra-compartmental pressure reaches the diastolic blood pressure, the arterial inflow will be compromised, and the leg will become ischaemic. This causes a sensory +/- motor deficit in the distal distribution. Next, the traversing nerves are compressed. This increases the intra-compartmental pressure further. This increases the hydrostatic pressure within them, causing fluid to move down its gradient and out of the veins in to the compartment. 2).Īs pressure increase, the veins will be compressed.

Other causes include iatrogenic vascular injury, tight casts or splints, deep vein thrombosis, and post-reperfusion swelling.įascial compartments are closed and cannot be distended consequently, any fluid that is deposited therein will cause an increase in the intra-compartmental pressure (Fig. Figure 1 – Cross section of the muscles of the distal forearm, highlighting those of the posterior compartment PathophysiologyĬompartment syndrome typically occurs following high-energy trauma, crush injuries, or fractures that cause vascular injury.