1. ACUTE COMPARTMENT SYNDROME
OF EXTREMETIES
M. Rustom
MRCS ( Eng )
MS Surg-Plastic UM
Fellowship in Plastic & Reconstructive Surgery UM

2. PLASTIC SURGERY
VASCULAR SURGERY
COMPARTMENT
SYNDROME
ORTHOPEDIC
TRAUMA SURGERY

3. Contents Definition Aetiology Epidemiology
Pathophysiology & Pathogenesis
Clinical Presentation
Management
Sequele & Complications
Challenges

4. DEFINITION

5. Acute compartment syndrome (ACS) is a condition where osseofascial compartment pressures rise to a point that overcomes capillary perfusion pressure.
The lack of tissue perfusion in ACS results in tissue ischemia and necrosis, which can lead to permanent loss of muscle function, nerve damage, limb amputation, and multisystem organ failure.
All limbs can be affected, leg, forearm, hands, feet, buttock.

6. EPIDEMIOLOGY & RISK FACTORS

7. The incidence of ACS is 3.1/100,000 people annually.
Men are ten times more likely to develop ACS.
The average age for ACS diagnosis is 32-years-old.
High-VELOCITY INJURIES and polytrauma carries higher risk.
Open fracture or closed fracture ?

8. AETIOLOGY

9. INCREASED COMPARTMENTAL CONTENTS DECREASED COMPARTMENTAL SPACE
Crush syndrome
Burns (circumferential)
Revascularization
Muscle hernia repair
Infiltrated fluid infusion
Casts
Arterial puncture
Circumferential dressings
Gunshot wound
Pneumatic antishock garments
Snake / venomous bite
Lithotomy surgical positioning
Nephrotic Syndrome
MEDICAL COMORBIDITIES [2]
Hematogenous osteomyelitis
Diabetes
Exercise (chronic compartment syndrome)
Coagulopathies

11. PATHOPHYSIOLOGY
&
PATHOGENESIS

13. CLINICAL MANIFESTATION

15. DIAGNOSIS

16. High index of clinical suspicion.
May require closed repeated assessment if uncertain
Head trauma, spinal injury, intoxicated patient & patient undergoing prolong surgery ( diagnosis can be missed )
Measurement of intra compartment pressure
Near-InfraRed (NIR) spectroscopy is an imaging technique, based on the same principle as pulse oximetry
Biomarkers ( e.g., creatinine phosphokinase & myoglobin ) may be elevated but they are not specific.

17. MANAGEMENT

18. Differential Pressure < 30 Differential Pressure 20-30
ACS Suspected
Differential Pressure < 30
Differential Pressure 20-30
Differential Pressure > 20
Fasciotomy
Observe +/- get expert opinion
Unlikely ACS, preventive measures

19. Diagnosed earlier than 8-12 H
ACS Confirmed
Diagnosed H
Diagnosed Later than 24 H
Diagnosed earlier than 8-12 H
Immediate fasciotomy
Controversial, take another opinion, council the patient & family
DO NOT DO FACIOTOMY

21. Adequate hydration and O2 supplementation are important.
Position the limb flat ( at the level of the heart ).
Remove the external pressure if any ( dressing, splints, traction,....).
Do not deprive from analgesia.
Check the renal function closely.
Upon fasciotomy, all involved compartment needs to be decompressed.
Patients must be educated on both the complications of ACS and the potential complications of surgery.

22. Post fasciotomy wound management
Cover with antibiotics.
Negative pressure wound therapy is the dressing of choice.
Avoid placing tensions sutures.
Do debridement as necessary.
Delayed primary closure or skin grafting once the oedema subsides.

24. SEQUELE
&
COMPLICATIONS

25. Only 68% of those treated with fasciotomy earlier than 12 H recovers well.
Untreated ACS leads to loss of limb function, necrosis & carries high risk of amputation.
Delayed fasciotomy increases the risk of infection, amputation & prolongs the hospital stay.
Systemic complications includes: renal impairment, sepsis & multi organ failure.

26. THANK YOU