Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.

Intracoelomic pressure and coelomic perfusion pressure in healthy tegus (Salvator merianae) / Mensuração da pressão intracelomática e da pressã de perfusão celomática em teiús saudáveis (Salvator merianae)

ABSTRACT: The evaluation of intracoelomic pressure is very important, as many diseases can culminate with an increase in intracoelomic pressure and a consequent reduction in perfusion of the abdominal organs. The aim of this study was to measure the intracoelomic pressure and coelomic perfusion pressure in tegus (Salvator merianae). Twelve healthy tegus without sexual distinctions, weighing 1.64±0.39kg, were enrolled in this study. Intracoelomic pressure was measured using two methods: a handmade water column system and a pressure transducer connected to a multiparameter monitor. Coelomic perfusion pressure was determined by subtracting the intracoelomic pressure from the mean arterial pressure, which was measured using an oscillometric method. Intracoelomic pressure was 0mmHg (range, 0 - 0.5) according to the water column method and 2mmHg (range, 0 - 2.0) according to the pressure transducer. Coelomic perfusion pressure was 76mmHg (range, 62 - 105) according to the water column system and 82mmHg (range, 57 - 93) according to the pressure transducer. No significant difference was observed between the values obtained by the different measurement methods. Intracoelomic pressure value reported in this study might be useful in tegus, but the coelomic perfusion pressure should be used with caution, considering the blood pressure method that was used.

RESUMO: A pressão intracelomática é um importante parâmetro, uma vez que muitas doenças culminam com o aumento da pressão intracelomática e consequentemente na redução da perfusão dos órgãos abdominais. O objetivo do estudo foi mensurar a pressão intracelomática e a pressão de perfusão celomática em teiús. Foram utilizados doze teiús hígidos, sem distinção sexual, pesando 1,64±0,39kg. A pressão intracelomática foi determinada pelo sistema de coluna de água e por um transdutor de pressão conectado a um monitor multiparamétrico. Já a pressão de perfusão celomática foi determinada pela subtração da pressão intracelomática do valor da pressão arterial média, sendo este obtido pelo método oscilométrico com o manguito posicionado na base da cauda. A pressão intracelomática mensurada pelo sistema de coluna de água foi 0mmHg [0 - 0,5] e pelo transdutor de pressão foi 2mmHg [0 - 2,0]. A pressão de perfusão celomática obtida pelo sistema de coluna de água foi 76mmHg [62 - 105] e pelo transdutor de pressão foi 82mmHg [57 - 93]. Não foram detectadas diferenças estatísticas entre os métodos de mensuração. Os valores de pressão intracelomática obtidos podem ser úteis para avaliação clínica em teiús, mas os valores de pressão de perfusão celomática devem ser utilizados com cautela, a considerar o método de mensuração da pressão arterial.

Compartment syndrome as a complication of the lithotomy position / El síndrome de compartimiento como complicación de la posición de litotomía

Compartment syndrome is a rare but serious complication of surgical procedures performed in the lithotomy position. Preventive measures include careful placement of the patient's legs and limited elevation. Early diagnosis is based on vigilance and close postoperative follow-up, especially after prolonged surgery. Finally, postoperative analgesia does not delay the diagnosis, if the patient's needs are assessed carefully.

El síndrome de compartimiento es una complicación rara pero seria de los procedimientos quirúrgicos realizados en posición de litotomía. Las medidas preventivas incluyen colocación cuidadosa de las piernas de la paciente y elevación limitada. El diagnóstico temprano se basa en la vigilancia y el seguimiento cercano post-operatorio, especialmente luego de una cirugía prolongada. Finalmente, la analgesia post-operatoria no demora el diagnóstico, si las necesidades de la paciente son evaluadas con cuidado.