Transcript PRESENTATION NAME - Medical Student LC

Principles of Fasciotomy
And a Review of Compartment Syndrome
September 24, 2008
Wendy Ng
Medical Student
Objectives
• Case example
• Review of compartment syndrome
– Definition
– Physical exam findings
– Forearm compartments
– Pathophysiology
– Treatment
• Methods of fasciotomy for the upper
extremity: forearm and hand
The Case
• 49 year old female with history of multiple
sclerosis, otherwise healthy. No
medications. Poor mobility, weak from
multiple sclerosis.
• At approximately 10 PM, she fell while
getting out of the tub, catching her left arm
in a towel rack. She could not move due to
weakness.
The Case
The Case
• When she arrived to the emergency room:
– Her left forearm was insensate
– She could no longer move her fingers, wrist
and elbow
– Her forearm was firm and indurated
– No palpable pulses
– She had exquisite pain
The Case
The Case
• She was taken to the OR emergently
– Release of volar, dorsal and lateral
compartments, as well as dorsal interossei,
and acute carpal tunnel release
– No digital releases
Compartment Syndrome
A compartment syndrome is defined as:
Increased tissue pressure within a limited
or closed space that compromises
circulation, initiating subcritical perfusion to
the tissues within the compartment.
Pathophysiology
Increased compartment pressure
 increase in venous pressure in
postcapillary venules
 increase in hydrostatic fluid shift to
extracellular space
 decrease in capillary blood flow
 muscle and nerve tissue ischemia
History
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Pain, especially when muscle stretched
Numbness, paralysis
Muscle paresthesias
Muscle feels tight or full
History of trauma to forearm
History of pressure on forearm
Physical Exam
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Pain
Passive stretch test
Decreased sensation or paresthesia
Progressive muscle weakness
Excessive swelling
Palpable firmness of the compartment
Resting position of the extremity
Forearm Compartments
Diagram from Achaur et al, 2000.
Treatment
• Noninvasive/preventative:
– Elevation
– Splinting
– Enzymatic debridement
Invasive Treatments
• Fasciotomy
– Volar forearm fasciotomy
• Include release of carpal tunnel
– Dorsal fasciotomy
– Interosseous compartments
– Thenar and hypothenar compartments
Volar fasciotomy
Photo credit: Achaur et al, 2000.
Dorsal fasciotomy
Photo credit: Achaur et al, 2000.
Thenar & Hypothenar
Photo credit: Achaur et al, 2000.
Interosseous
Photo credit: Achaur et al, 2000.
Conclusion
• Compartment syndrome can be identified
through history and physical exam
• Anatomy is relevant when planning
fasciotomies
References
• Achaur, BM. Eriksson E, Guyuron B et al.
(2000.) Plastic Surgery: Indications, Operations,
and Outcomes. Volume Four. Mosby Publishing,
St. Louis.
• Thorne, CH. (Ed.) (2007.) Grabb & Smith’s
Plastic Surgery. 6th Edition. Lippincott Williams &
Wilkins, Philadelphia.
• Doherty GM, Lowney JK, Mason JE et al. (Eds.)
(2002. )The Washington Manual of Surgery.
Third Edition. Lippincott Williams & Wilkins, St.
Louis.
Thanks!
Special thanks to Geethan and Shannon
for assisting in the preparation of this presentation!