Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases.
ABSTRACT To investigate the occurrence of compartment syndrome and the results of fasciotomy in vascular surgical patients.
Retrospective study of case records from 1980-1994.
Fifty-seven limbs in 53 patients had fasciotomies following surgical revascularisation. Fifty-three (93%) limbs were acutely ischaemic, while four (7%) had undergone elective vascular surgery. Forty-four (77%) limbs had signs of compartment syndrome, while 13 (23%) fasciotomies were prophylactic.
The fasciotomies were done as subcutaneous procedures (n = 40), as double-incision fasciotomies (n = 11), or by an unknown method (n = 6). The skin incisions were closed primarily in 26 (46%) cases, delayed primarily in 11 (19%) cases, and by skin grafting in eight cases (14%).
Five (13%) subcutaneous fasciotomies required revision. Surgical debridement was required in four (7%) limbs. At discharge, 36 (68%) patients had kept their limbs, 11 (21%) patients were amputated, and six (11%) had died. No complications relating to the fasciotomies were observed.
Compartment syndrome is usually related to acute ischaemia and rarely following elective vascular surgery. Subcutaneous fasciotomy does not always ensure sufficient decompression of all four lower leg compartments. Complications related to fasciotomy are rare.
- Journal of Vascular Surgery 02/1990; 11(1):181. · 2.88 Impact Factor
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ABSTRACT: Swelling is known to occur after peripheral revascularization. In this study of 14 patients undergoing revascularization of the popliteal artery for severe ischaemia, leg swelling and intramuscular pressure were recorded before and after operation. Calf circumference increased with a maximum swelling of 3.9 +/- 1.1 cm on postoperative day 6. There was a gradual increase in intramuscular pressure from 9 +/- 2 mmHg on the day before operation in the anterior tibial compartment to a maximum pressure on postoperative days 6-7 of 26 +/- 4 mmHg. Similar intramuscular pressure changes were seen in the superficial posterior compartment. These high intramuscular pressures may lead to a compartment syndrome and perhaps graft failure, which was actually observed in one case. Deep-vein thrombosis in the postoperative course may contribute to the high intramuscular pressures. Phlebography revealed a deep-vein thrombosis in 2 patients. In conclusion popliteal revascularization causes leg swelling and increased intramuscular pressure which may lead to a compartment syndrome and graft failure. Therefore follow-up of intramuscular pressure in patients with marked swelling after distal revascularization procedures and early fasciotomy may be considered on wide indications.British Journal of Surgery 10/1983; 70(9):539-41. · 4.84 Impact Factor
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ABSTRACT: Surgical decompression remains the only effective treatment for the ischemia of the muscles and nerves of the leg that constitutes the principal defects in the compartment syndromes. Recently, partial fibulectomy has been proposed as a good way to decompress all four compartments instead of the older double incision. Both methods are effective in satisfactorily reducing intracompartmental pressures, as documented by our wick catheter measurements. However, the double-incision technique is easier, faster, safer, and is the treatment of choice when four-compartment decompressive fasciotomy is indicated.The Journal of Bone and Joint Surgery 04/1977; 59(2):184-7. · 3.23 Impact Factor