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

Abstract

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.

Continuous Compartment Pressure Monitoring Allows the Early Detection of Compartment Syndrome After Arterial Revascularization

“…It has been seen in large database studies [ 7 ] that a disproportionate number of fasciotomies are being done to avoid missing the diagnosis. This has been seen with a high number of false negatives from reliance on only clinical exams [ 11 ]. An even higher number of false positives has resulted in a large number of unnecessary surgeries as well [ 11 ].…”

“…This has been seen with a high number of false negatives from reliance on only clinical exams [ 11 ]. An even higher number of false positives has resulted in a large number of unnecessary surgeries as well [ 11 ].…”

“…Preclinical and clinical studies have shown that this is more accurate than previous technology [ 8 ]. These same studies have also shown that only one compartment, ideally the anterior, needs to be monitored [ 8 , 11 ]. It also allows real-time pressure value monitoring in a continuous manner that has not previously been possible [ 2 ].…”

“…The MEMS-based pressure monitor [ 2 ] was inserted as per protocol in the anterior compartment of the right leg [ 11 ]. The image (Figure 1 ) was supplied by the manufacturer, MY01 Inc. (Quebec, Canada).…”

Resolution of Confusion Over Compartment Syndrome After Tibial Osteotomy With Continuous Pressure Measurements

“…There is real-time pressure monitoring in a continuous manner that had not previously been available. The recent studies centered on this process have established new standards in CS diagnosis and treatment [ 8 , 10 , 11 ]. The important innovation in care with continuous monitoring is avoiding unnecessary fasciotomies, with all the attendant complications, while allowing early recognition of true positives.…”