Diagnosis and Treatment of Compartment Syndrome in Deep Burns

Abstract

Burn injuries and their treatment is an important medical and social problem. Compartment syndrome is a serious complication of deep circular burns, which causes increased subfascial pressure and local tissue ischemia with the development of intercellular interstitial edema and a significant rise of intra−tissue pressure, which exacerbates tissue blood supply, enhancing the tissue hypoxicity. Treatment is performed by necrotomy, which due to decompression helps to reduce intra−tissue pressure and reduce the scale of necrobiotic processes in damaged tissues. To develop a method to treat deep subfascial burns, a study was conducted in 15 patients. Dynamic monitoring of tissue pressure in the fascial sheaths of each muscle allowed to determine the direction and degree of degenerative−destructive changes caused by zonal microcirculation disorders, increasing edema, hypoxia, ischemia and necrosis of individual muscle fibers, which helped to determine the need for surgery. The method of treatment included decompression necrofasciotomies with opening of zonal fascial−aponeurotic muscular bed−cases of the first order in the paranecrosis areas; general anti−shock and detoxification therapy; local ozone therapy with a complex of cytoprotectants and antioxidants; necrectomy and autodermoplasty. According to the results of the study, it is concluded that an important place in treatment of the compartment syndrome in the patients with deep burns is the objectification of intra−tissue pressure. The method of determining the dynamics of compartment syndrome and surgical tactics will allow preserving the viability of a significant part of the damaged muscle mass, reduce the volume of tissues that underwent necrectomy, restore the skin timely. Key words: burns, compartment syndrome, intratissue pressure, surgical treatment.