Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome

Abstract

Chronic compartment syndrome (CCS) is usually considered to be due to ischaemia of muscle. We have attempted to use the direct measurement of muscle blood flow for diagnosis since the assessment of intracompartmental pressure does not provide accurate knowledge of the vascular state. We recorded simultaneously continuous measurements of the laser Doppler flow (LDF) in muscle and the intracompartment pressure (ICP) after exercise in seven patients with CCS, and in seven control subjects.The mean ICP was 74.1 ± 4.4 mmHg in CCS patients and 24.2 ± 3.4 mmHg in control subjects one minute after exercise, decreasing to 34.6 ± 2.3 mmHg and 15.0 ± 1.6 mmHg at 20 min, respectively. The LDF was 0.80 ± 0.11 arbitrary units (AU) in control subjects and 1.09 ± 0.14 AU in CCS patients one minute after exercise, and 0.41 ± 0.11 AU and 0.27 ± 0.04 AU, respectively, at the end of the recovery period.The ICP showed a progressive decrease over time in both groups. The LDF decreased sharply during the first minutes of recovery in control subjects, but in patients with CCS there was a delayed hyperaemic peak with blood flow reaching 0.84 ± 0.10 AU at nine minutes as against 0.33 ± 0.06 AU for control subjects (p < 0.01). The ICP increased in both control subjects and CCS patients after exercise with no clear cut-off point between the groups. By contrast, changes in muscle blood flow over time were clearly different between control subjects and patients with CCS.For this reason, LDF should be investigated further as a technique for the diagnosis of CCS.J Bone Joint Surg [Br] 1998;80-B:365-9.

Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome

“…Raised ICP is believed to play an important role in the pathophysiology of CECS, and fasciotomy reportedly yields a good clinical outcome and normalized ICP [11,13,14,25]. Ischemia secondary to a raised ICP is believed to cause the pain symptoms [1,8,17,19].…”

Fraturas da diáfise da tíbia

“…Studies show similarity between the various methods for measuring intracompartmental pressure (8)(9)(10) . According to McQueen et al (7) , monitoring of patients who presented a difference in the compartmental pressure and diastolic blood pressure ≤ 30 mmHg showed normal muscle function, even without compartmental release.…”

Compartment Syndrome of the Upper Extremity

“…68,69 Monitoring of the deep flexor compartment of the forearm was found to be safely accessed via an approach from the midline toward the ulna, between the tendons of the flexor carpi radialis and palmaris longus. 68 Various methods of measuring interstitial tissue pressures have been described, as follows: 72,73 New technologies such as laser Doppler flowmetry 74 and 99Tcm-methoxy-isobutryl isonitril scintigraphy 75 are less invasive and have certain appeal; however, they remain less practical in the emergent setting and are not yet cost-effective. Near-infrared spectroscopy has been used to detect changes and trends in relative oxygen saturation of hemoglobin involving a noninvasive mechanism similar to that of pulse oximetry.…”