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Pathophysiology and Management of Limb Compartment Syndromes

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Mechanisms of Vascular Disease

Abstract

The pathophysiology of acute extremity compartment syndrome involves external compression or internal expansion within the compartment leading to increased tissue pressure, reduced capillary blood flow, tissue hypoxia and necrosis. Acute limb compartment syndrome in vascular surgery is mostly related to ischemia-reperfusion injury associated with acute ischemia or vascular trauma. The upper arm contains two compartments (anterior/posterior), forearm three (volar/lateral/dorsal), thigh three (anterior/medial/posterior), and lower leg four compartments (anterior/lateral/deep posterior/superficial posterior). The time from insult to the development of compartment syndrome may vary from minutes to hours. Any suspicion of acute limb compartment syndrome must lead to either prompt treatment or immediate further diagnostics which may include pressure measurement. Acute limb compartment syndrome should be treated with fasciotomy of all affected compartments. The lower limb is decompressed with anterolateral and posteromedial incisions. Incisions in skin and fascia need to be long enough to make tissues loose and allow for postoperative swelling. When fasciotomy is performed within 6 h of onset, the majority of extremities return to normal function but later fasciotomy is associated with significant complications including neuromuscular dysfunction and amputation.

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References

  1. von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386:1299–310. https://doi.org/10.1016/S0140-6736(15)00277-9.

    Article  Google Scholar 

  2. Wesslen C, Wahlgren CM. Contemporary management and outcome after lower extremity fasciotomy in non-trauma-related vascular surgery. Vasc Endovascular Surg. 2018;52:493–7. https://doi.org/10.1177/1538574418773503.

    Article  PubMed  Google Scholar 

  3. McNally MM, Univers J. Acute limb ischemia. Surg Clin North Am. 2018;98:1081–96. https://doi.org/10.1016/j.suc.2018.05.002.

    Article  PubMed  Google Scholar 

  4. Modrall JG. Compartment syndrome. In: Rutherfords vascular surgery and endovascular therapy. 7th ed. 2010. p. 2412–21.

    Google Scholar 

  5. Jensen SL, Sandermann J. Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases. Eur J Vasc Endovasc Surg. 1997;13:48–53.

    Article  CAS  Google Scholar 

  6. Schmidt AH. Acute compartment syndrome. Orthop Clin North Am. 2016;47:517–25. https://doi.org/10.1016/j.ocl.2016.02.001.

    Article  PubMed  Google Scholar 

  7. Cone J, Inaba K. Lower extremity compartment syndrome. Trauma Surg Acute Care Open. 2017;2:e000094. https://doi.org/10.1136/tsaco-2017-000094.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Allenberg JR, Meybier H. [The compartment syndrome from the vascular surgery viewpoint]. Chirurg. 1988;59:722–7.

    Google Scholar 

  9. Papalambros EL, Panayiotopoulos YP, Bastounis E, Zavos G, Balas P. Prophylactic fasciotomy of the legs following acute arterial occlusion procedures. Int Angiol. 1989;8:120–4.

    CAS  PubMed  Google Scholar 

  10. Patman RD. Compartmental syndromes in peripheral vascular surgery. Clin Orthop Relat Res. 1975;113:103–10.

    Article  Google Scholar 

  11. Farber A, Tan TW, Hamburg NM, Kalish JA, Joglar F, Onigman T, et al. Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: a review of the National Trauma Data Bank. Injury. 2012;43:1486–91. https://doi.org/10.1016/j.injury.2011.06.006.

    Article  PubMed  Google Scholar 

  12. Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP. Acute limb compartment syndrome: a review. J Surg Educ. 2007;64:178–86. https://doi.org/10.1016/j.jsurg.2007.03.006.

    Article  PubMed  Google Scholar 

  13. Percival TJ, Rasmussen TE. Reperfusion strategies in the management of extremity vascular injury with ischaemia. Br J Surg. 2012;99(Suppl 1):66–74. https://doi.org/10.1002/bjs.7790.

    Article  PubMed  Google Scholar 

  14. Ledgerwood AM. Management of extremity compartment syndrome. In: Current surgical therapy. 11th ed. 2014. p. 1124–8.

    Google Scholar 

  15. Matsen FA 3rd. Compartmental syndromes. N Engl J Med. 1979;300:1210–1. https://doi.org/10.1056/NEJM197905243002108.

    Article  PubMed  Google Scholar 

  16. Janzing HM. Epidemiology, etiology, pathophysiology and diagnosis of the acute compartment syndrome of the extremity. Eur J Trauma Emerg Surg. 2007;33:576–83. https://doi.org/10.1007/s00068-007-7151-0.

    Article  PubMed  Google Scholar 

  17. Gillani S, Cao J, Suzuki T, Hak DJ. The effect of ischemia reperfusion injury on skeletal muscle. Injury. 2012;43:670–5. https://doi.org/10.1016/j.injury.2011.03.008.

    Article  PubMed  Google Scholar 

  18. Crawford RS. Ischemia-reperfusion. In: Rutherford’s vascular surgery and endovascular therapy. 7th ed. 2010. p. 89–100.

    Google Scholar 

  19. Santistevan JR. Acute limb ischemia: an emergency medicine approach. Emerg Med Clin North Am. 2017;35:889–909. https://doi.org/10.1016/j.emc.2017.07.006.

    Article  PubMed  Google Scholar 

  20. Seal JB, Gewertz BL. Vascular dysfunction in ischemia-reperfusion injury. Ann Vasc Surg. 2005;19:572–84. https://doi.org/10.1007/s10016-005-4616-7.

    Article  PubMed  Google Scholar 

  21. Yassin MM, Harkin DW, Barros D'Sa AA, Halliday MI, Rowlands BJ. Lower limb ischemia-reperfusion injury triggers a systemic inflammatory response and multiple organ dysfunction. World J Surg. 2002;26:115–21. https://doi.org/10.1007/s00268-001-0169-2.

    Article  PubMed  Google Scholar 

  22. Chafin B, Belmont MJ, Quraishi H, Clovis N, Wax MK. Effect of clamp versus anastomotic-induced ischemia on critical ischemic time and survival of rat epigastric fasciocutaneous flap. Head Neck. 1999;21:198–203.

    Article  CAS  Google Scholar 

  23. Percival TJ, White JM, Ricci MA. Compartment syndrome in the setting of vascular injury. Perspect Vasc Surg Endovasc Ther. 2011;23:119–24. https://doi.org/10.1177/1531003511401422.

    Article  PubMed  Google Scholar 

  24. Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16:572–7.

    Article  Google Scholar 

  25. Shuler FD, Dietz MJ. Physicians’ ability to manually detect isolated elevations in leg intracompartmental pressure. J Bone Joint Surg Am. 2010;92:361–7. https://doi.org/10.2106/JBJS.I.00411.

    Article  PubMed  Google Scholar 

  26. Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21:680–8.

    CAS  PubMed  Google Scholar 

  27. Livingston KS, Glotzbecker MP, Shore BJ. Pediatric acute compartment syndrome. J Am Acad Orthop Surg. 2017;25:358–64. https://doi.org/10.5435/JAAOS-D-15-00655.

    Article  PubMed  Google Scholar 

  28. Orrapin S, Orrapin S, Arwon S, Rerkasem K. Predictive factors for post-ischemic compartment syndrome in non-traumatic acute limb ischemia in a lower extremity. Ann Vasc Dis. 2017;10:378–85. https://doi.org/10.3400/avd.oa.17-00055.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Boody AR, Wongworawat MD. Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices. J Bone Joint Surg Am. 2005;87:2415–22. https://doi.org/10.2106/JBJS.D.02826.

    Article  PubMed  Google Scholar 

  30. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;113:43–51.

    Article  Google Scholar 

  31. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996;78:99–104.

    Article  CAS  Google Scholar 

  32. Mitas P, Vejrazka M, Hruby J, Spunda R, Pecha O, Lindner J, et al. Prediction of compartment syndrome based on analysis of biochemical parameters. Ann Vasc Surg. 2014;28:170–7. https://doi.org/10.1016/j.avsg.2012.12.006.

    Article  PubMed  Google Scholar 

  33. Klucka J, Stourac P, Stouracova A, Masek M, Repko M. Compartment syndrome and regional anaesthesia: critical review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161:242–51. https://doi.org/10.5507/bp.2017.025.

    Article  PubMed  Google Scholar 

  34. Giannoudis PV, Tzioupis C, Pape HC. Early diagnosis of tibial compartment syndrome: continuous pressure measurement or not? Injury. 2009;40:341–2. https://doi.org/10.1016/j.injury.2009.02.010.

    Article  PubMed  Google Scholar 

  35. Steffen RJ, Sale S, Anandamurthy B, Cruz VB, Grady PM, Soltesz EG, et al. Using near-infrared spectroscopy to monitor lower extremities in patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg. 2014;98:1853–4. https://doi.org/10.1016/j.athoracsur.2014.04.057.

    Article  PubMed  Google Scholar 

  36. Boezeman RP, Moll FL, Unlu C, de Vries JP. Systematic review of clinical applications of monitoring muscle tissue oxygenation with near-infrared spectroscopy in vascular disease. Microvasc Res. 2016;104:11–22. https://doi.org/10.1016/j.mvr.2015.11.004.

    Article  PubMed  Google Scholar 

  37. Song W, Zhou D, Dong J. Predictors of secondary amputation in patients with grade IIIC lower limb injuries: a retrospective analysis of 35 patients. Medicine (Baltimore). 2017;96:e7068. https://doi.org/10.1097/MD.0000000000007068.

    Article  Google Scholar 

  38. Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. 1976;58:112–5.

    Article  CAS  Google Scholar 

  39. Williams AB, Luchette FA, Papaconstantinou HT, Lim E, Hurst JM, Johannigman JA, et al. The effect of early versus late fasciotomy in the management of extremity trauma. Surgery. 1997;122:861–6.

    Article  CAS  Google Scholar 

  40. Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40:342–4.

    Article  CAS  Google Scholar 

  41. Bible JE, McClure DJ, Mir HR. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. J Orthop Trauma. 2013;27:607–11. https://doi.org/10.1097/BOT.0b013e318291f284.

    Article  PubMed  Google Scholar 

  42. Mathis JE, Schwartz BE, Lester JD, Kim WJ, Watson JN, Hutchinson MR. Effect of lower extremity fasciotomy length on intracompartmental pressure in an animal model of compartment syndrome: the importance of achieving a minimum of 90% fascial release. Am J Sports Med. 2015;43:75–8. https://doi.org/10.1177/0363546514554601.

    Article  PubMed  Google Scholar 

  43. Ojike NI, Roberts CS, Giannoudis PV. Compartment syndrome of the thigh: a systematic review. Injury. 2010;41:133–6. https://doi.org/10.1016/j.injury.2009.03.016.

    Article  PubMed  Google Scholar 

  44. Janzing HM, Broos PL. Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients. J Orthop Trauma. 2001;15:438–41.

    Article  CAS  Google Scholar 

  45. Johnson LS, Chaar M, Ball CG, Perez S, Nicholas JM, Wyrzykowski AD, et al. Management of extremity fasciotomy sites prospective randomized evaluation of two techniques. Am J Surg. 2018;216:736–9. https://doi.org/10.1016/j.amjsurg.2018.07.033.

    Article  PubMed  Google Scholar 

  46. Kakagia D, Karadimas EJ, Drosos G, Ververidis A, Trypsiannis G, Verettas D. Wound closure of leg fasciotomy: comparison of vacuum-assisted closure versus shoelace technique. A randomised study. Injury. 2014;45:890–3. https://doi.org/10.1016/j.injury.2012.02.002.

    Article  CAS  PubMed  Google Scholar 

  47. Jauregui JJ, Yarmis SJ, Tsai J, Onuoha KO, Illical E, Paulino CB. Fasciotomy closure techniques. J Orthop Surg. 2017;25:2309499016684724. https://doi.org/10.1177/2309499016684724.

    Article  Google Scholar 

  48. Shah DM, Bock DE, Darling RC 3rd, Chang BB, Kupinski AM, Leather RP. Beneficial effects of hypertonic mannitol in acute ischemia—reperfusion injuries in humans. Cardiovasc Surg. 1996;4:97–100.

    Article  CAS  Google Scholar 

  49. Robins M, Wyatt HA. Hyperbaric ischemia reperfusion injury. Treasure Island: StatPearls; 2018.

    Google Scholar 

  50. Bocca G, van Moorselaar JA, Feitz WF, van der Staak FH, Monnens LA. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position. J Nephrol. 2002;15:183–5.

    PubMed  Google Scholar 

  51. Zeng X, Zhang L, Wu T, Fu P. Continuous renal replacement therapy (CRRT) for rhabdomyolysis. Cochrane Database Syst Rev. 2014;(6):CD008566. https://doi.org/10.1002/14651858.CD008566.pub2.

  52. Johnson SB, Weaver FA, Yellin AE, Kelly R, Bauer M. Clinical results of decompressive dermotomy-fasciotomy. Am J Surg. 1992;164:286–90.

    Article  CAS  Google Scholar 

  53. Rush DS, Frame SB, Bell RM, Berg EE, Kerstein MD, Haynes JL. Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization? J Vasc Surg. 1989;10:343–50.

    Article  CAS  Google Scholar 

  54. Ris HB, Furrer M, Stronsky S, Walpoth B, Nachbur B. Four-compartment fasciotomy and venous calf-pump function: long-term results. Surgery. 1993;113:55–8.

    CAS  PubMed  Google Scholar 

  55. Wall CJ, Lynch J, Harris IA, Richardson MD, Brand C, Lowe AJ, et al. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma. ANZ J Surg. 2010;80:151–6. https://doi.org/10.1111/j.1445-2197.2010.05213.x.

    Article  PubMed  Google Scholar 

  56. Lollo L, Grabinsky A. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital. Int J Crit Illn Inj Sci. 2016;6:133–42. https://doi.org/10.4103/2229-5151.190648.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Heemskerk J, Kitslaar P. Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies. World J Surg. 2003;27:744–7. https://doi.org/10.1007/s00268-003-6691-7.

    Article  PubMed  Google Scholar 

  58. Erdos J, Dlaska C, Szatmary P, Humenberger M, Vecsei V, Hajdu S. Acute compartment syndrome in children: a case series in 24 patients and review of the literature. Int Orthop. 2011;35:569–75. https://doi.org/10.1007/s00264-010-1016-6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    David Lindström

  2. Department of Vascular Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

    Carl-Magnus Wahlgren

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  1. David Lindström
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  2. Carl-Magnus Wahlgren
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Correspondence to David Lindström .

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  1. Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia

    Robert Fitridge

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Lindström, D., Wahlgren, CM. (2020). Pathophysiology and Management of Limb Compartment Syndromes. In: Fitridge, R. (eds) Mechanisms of Vascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-43683-4_20

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  • DOI: https://doi.org/10.1007/978-3-030-43683-4_20

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