Abstract

RECENT METHODS IN MANAGEMENT OF LOWER LIMB COMPARTMENT SYNDROME

Gamal Sharkas*, Mohamed El-Taweel, Abdullah El-Sayed and Ashraf Ewida

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Abstract

Background: Compartment syndrome (CS) is the clinical condition characterized by raised pressure within a “non-expandable” anatomical compartment, which is surrounded by fascia and bone. CS is a severe complication caused by bleeding or edema and it can occur following fractures or soft tissue trauma, burns and reperfusion injury following acute arterial obstruction. Although its incidence is relatively low, clinical awareness of this complication, early recognition and appropriate treatment with fasciotomies are of paramount importance to minimize the risk of irreversible damage and permanent disability. Objective: The aim of this work is to put some spotlights on compartmental syndrome in lower limb as regard recent modalities in diagnosis and treatment of established acute compartment syndrome. Patient and Methods: This is a prospective study included 30 patients who were admitted between April 2017 and April 2018, with lower limb compartmental syndrome requiring surgical treatment, admitted or referred to Al- Hussein University Hospital, Department of Vascular Surgery. 30 patients with were suspected to have acute compartment syndrome. In Nine patients with suspected acute compartment syndrome, the primary tissue pressure measurement at admission in one compartment was below (20mmHg). Two patients was diagnosed as acute compartment syndrome of leg by clinical examination. In 17 patients, the diagnosis of acute compartment syndrome was made based on clinical examination and compartment pressure measurements. In Two patients positive symptoms and signs was present while compartment pressure measurements revealed tissue pressure at (20mmHg). The measurement was reported after 4 hours and increased to (30 mmHg). Results: The functional results according to Rorabeck was 11 out of 19 patients had acceptable results (57.8 %) and 8 out of 19 patients had unacceptable results (42.1 %). Superficial infection in the wound of fasciotomy was present in 17 patients (80.9%) that were managed by daily dressing. Deep infection was happened in two patients (9.5%) who required serial debridement and removal of necrotic muscle until skin closure by delayed primary skin closure. Three patients had persistent pain (14.2%). 14 patients had persistent numbness (66.6%). While three patients improved within 4 weeks. Eight patients had persistent sensory deficit (38%).Three patients had persistent motor weakness (14.2%) and three patients had major amputations (14.2%). Conclusion: The diagnosis of acute compartment syndrome depends on clinical examination and measurement of compartment pressure, which is preferred to be by continuous monitoring for at least the first (12 hours). Adequate fasciotomy within reasonable time first (12 hours) by single or double incision is the treatment of choice of this syndrome however the rate of re-operation still high and the complication is warranted.

Keywords: Compartment syndrome, diagnosis, proper fasciotomy.