A cadaveric model of anterior compartment leg syndrome: Subcutaneous minimally invasive fasciotomy versus open fasciotomy

Vandergugten, Simon; Zemmour, Laurent; Lengelé, Benoît; Behets, Catherine

doi:10.1016/j.otsr.2018.10.003

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…The discrepancy between inline pressure measurements and compartment pressure measurements provides insight into modeling ACS and interpreting the results of older papers. Some studies have utilized an inline pressure sensor as representative of compartment pressure 32,38 . The results of this study and others 28 have suggested that pressure readings measured inline to the infusion may not always be representative of the compartment pressure.…”

Section: Discussionmentioning

confidence: 99%

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Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete

Schupbach

Honjol

Bouklouch

et al. 2022

Journal of Bone and Joint Surgery

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Background:Clinical case series have indicated that 1 or 2-compartment decompression of the anterior or lateral leg may be sufficient for release, but, currently, no cadaveric model has verified that approach. The objective of this study was to investigate the functional relationship between compartments by alternating sequences of infusion and fasciotomy release.Methods:This study utilized multicompartment sequential pressurization with simultaneous monitoring by continuous pressure sensors to model compartment syndrome in a human cadaver leg. Subsequent sequential release of compartments and continuous streaming of pressure readings permitted unique insights.Results:A leg model allowed the examination of pressure changes in all 4 compartments as treated with sequential fasciotomies. The successful modeling of lower-leg pressures consistent with compartment syndrome showed that discrepancies relative to accepted concepts were seen when the deep posterior compartment was pressurized in isolation. Also, release of 1 of the 2 of either the anterior or lateral compartments seems to be sufficient for decompression to acceptable pressure levels.Conclusions:The deep posterior compartment does not appear to be completely discrete and instead follows the pressurization curve of the posterior muscle group. This indicates that release of the deep posterior compartment may not be needed in all acute compartment syndrome scenarios.Clinical Relevance:Surgical techniques can be modified for treatment of acute compartment syndrome to avoid large scar lengths, deep dissection, and multiple exposures that could improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Infusion was performed for 1 compartment at a time. The pump pressure setpoint was between 30 and 35 mm Hg 32 . For each sample, the compartments were infused sequentially.…”

Section: Methodsmentioning

confidence: 99%

Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete

Schupbach

Honjol

Bouklouch

et al. 2022

Journal of Bone and Joint Surgery

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“…This factor did not affect the results of the current study as there was a pressure sensor in each of the compartments. Some studies have utilized an inline pressure sensor as representative of the compartment pressure 20,21 . The results of the present study are consistent with the literature and suggest that pressure readings measured inline with the infusion may not always be representative of the compartment pressure.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model

et al. 2021

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Background:Acute compartment syndrome of the foot is a controversial topic. Release of the foot has been seen as complicated because of large incisions and postoperative morbidity, and there has been debate over whether this procedure is actually effective for releasing all areas of increased pressure. New sensor technology affords the opportunity to advance our understanding of acute compartment syndrome of the foot and its treatment. The purpose of the present study was to determine whether percutaneous decompression could be performed for the treatment of compartment syndrome in a forefoot model.Methods:The present study utilized a validated continuous pressure sensor to model compartment syndrome in human cadaveric feet. We utilized a pressure-controlled saline solution infusion system to induce increased pressure. A novel percutaneous release of the forefoot was investigated to assess its efficacy in achieving decompression.Results:For all cadaveric specimens, continuous pressure monitoring was accomplished with use of a continuous pressure sensor. There were 4 discrete compartment areas that could be reliably pressurized in all feet. The average baseline, pressurized, and post-release pressures (and standard deviations) were 4.5 ± 2.9, 43.8 ± 7.7, and 9.5 ± 3.6 mm Hg, respectively. Percutaneous decompression produced a significant decrease in pressure in all 4 compartments (p < 0.05).Conclusions:With use of continuous compartment pressure monitoring, 4 consistent areas were established as discrete compartments in the foot. All 4 compartments were pressurized with a standard pump system. With use of 2 small dorsal incisions, all 4 compartments were successfully released, with no injuries identified in the cutaneous nerve branches, extensor tendons, or arteries. These results have strong implications for the future of modeling compartment syndrome as well as for guiding clinical studies.Clinical Relevance:A reproducible and accurate method of continuous pressure monitoring of foot compartments after trauma is needed (1) to reliably identify patients who are likely to benefit from compartment release and (2) to help avoid missed or evolving cases of acute compartment syndrome. In addition, a reproducible method for percutaneous compartment release that minimizes collateral structural damage and the need for secondary surgical procedures is needed.

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“…Several types of minimal incision fasciotomy have been reported for compartment syndrome 14 , 16 , 17 , 18 , 19 , 20 . However, most previous studies have considered cadaver models 18 , 19 , traumatic ACS in children 20 , or chronic exertional compartment syndrome 14 , 17 . There are still very few clinical reports describing fasciotomy techniques for ACS, especially after ECMO.…”

Section: Discussionmentioning

confidence: 99%

Interrupted Incision Fasciotomy for Acute Compartment Syndrome After Extracorporeal Membrane Oxygenation: Surgical Technique with a Report of Two Cases

Park

Kim

Cho

et al. 2021

Orthopaedic Surgery

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Background: After extracorporeal membrane oxygenation (ECMO), acute compartment syndrome (ACS) can develop because of limb ischemia or reperfusion. The standard treatment for ACS is emergency fasciotomy. We introduced an interrupted incision technique instead of a long double-incision to reduce blood loss and subsequent hypovolemia in ECMO patients.Case presentation: Two patients were treated venoarterial ECMO with heparinization by inserting cannulas into their right femoral vessels: Case #1 after emergency pulmonary thrombectomy for massive pulmonary thrombi and Case #2 after percutaneous coronary intervention for ST-elevation myocardial infarction with ventricular fibrillation. Some of the '5 P' signs of ACS were detected on their right legs. We treated them with the interrupted incision fasciotomy: four or five skin incisions of 2-3 cm each on lateral side; one 6-7 cm proximal skin incision with one or two separate short distal skin incisions of 1-1.5 cm each on the posteromedial side. The subcutaneous layer was also incised through these interrupted incisions; interrupted multiple "soft tissue tunnels" can be formed above muscle layer between the incisions. Once the fascia was exposed, the connected fasciotomy was performed with the knife blade facing subcutaneous layer, rather than muscle. The two patients' foot pulse, skin color, and muscle tone were immediately restored, and delayed primary wound closures were possible. Both patients were satisfied with their limb salvage and could walk with a little help using an orthosis or a cane. Conclusions:We recommend the interrupted incision fasciotomy as an attractive and effective technique for ACS, particularly after ECMO.

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A cadaveric model of anterior compartment leg syndrome: Subcutaneous minimally invasive fasciotomy versus open fasciotomy

Cited by 8 publications

References 22 publications

Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete

Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete

Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model

Interrupted Incision Fasciotomy for Acute Compartment Syndrome After Extracorporeal Membrane Oxygenation: Surgical Technique with a Report of Two Cases

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