![]() ![]() In a 2008 study, a cohort of 336 combat patients received 643 fasciotomies (upper and lower limb included). It did demonstrate the infection rate is significantly higher in patients whose fasciotomies were delayed. Ĭonversely, another more recent study has shown that there is no difference in limb salvage rate when comparing early (12 hours) fasciotomy. However, fasciotomies performed after 12 hours resulted in only 8% regaining normal limb function. One study has demonstrated that fasciotomies performed within 6 hours resulted in almost complete limb function recovery, between 6 and 12 hours normal functional recovery rate was 68%. The primary relative contraindication to performing a fasciotomy is delayed presentation if the clinician suspects compartment syndrome of having been present for more than 12 hours, there is a potential risk of reperfusion injury. ![]() Every decision to perform an emergency fasciotomy should be made by a senior team member and on a case-by-case basis in the context of the patient and the injury sustained. This section will explore the relative contraindications. There is no absolute contraindication to performing a fasciotomy. While some surgeons operate if a compartment pressure is greater than 30 mmHg with the correlation of clinical signs. Some institutes operate if the difference between the compartment pressure and diastolic pressure is less than 20 mmHg. No universal agreement exists on indications for emergency fasciotomy. Measuring compartment pressures is possible via multiple methods, none of which have robust supporting evidence. ![]() In these circumstances, monitoring of compartment pressures can be useful. These signs and symptoms can be challenging to assess depending on the conscious level, sensory state, and ability to communicate. Two-point discrimination can be useful for determining nerve ischemia. IndicationsĬlassical features of compartment syndrome are those of ischemia, pain out of proportion to the injury, paraesthesia, pallor, paralysis, and pain on passive movement, especially stretch of the concerned compartment. The radial nerve lies deep to the mobile wad. The median and ulnar nerves lie in the volar forearm between the flexor digitorum superficialis and profundus.
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