Fasciotomy

17,500 views 30 slides Oct 07, 2016
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About This Presentation

compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm


Slide Content

Dr. Joel Arudchelvam
Consultant Vascular and Transplant Surgeon
Teaching Hospital Anuradhapura

COMPARTMENT SYNDROME
Reduced organ perfusion due to increased
intra compartment pressure.
Compartment Perfusion Pressure (CPP)
Mean Arterial Pressure (MAP)
Intra Compartmental Pressure (ICP)
CPP = MAP – ICP

HISTORY
Richard von Volkmann[1](1881)
Described irreversible contractures of the muscles
because of ischemic processes
Hildebrand (1906)
first to suggest that elevated tissue pressure may be
related to ischemic contracture
Murphy (1914)
First to suggest that Fasciotomy might prevent the
contracture.
Volkmann R. Die ischaemischen Muskellahmungen and Kontrakturen. Zentralbl Chir. 1881;8:801–3

Can occur in any enclosed space;
Upper Arm
Forearm
Hand
Thigh
Leg
Foot
Abdomen
Chest
Cranial cavity
WHERE CAN IT
OCCUR

CAUSES OF COMPARTMENT
SYNDROME
Fracture s and haematoma
Crush injuries
Ischemia / Reperfusion
Tight bandages
Burns Eschar
Tourniquet

CLINICAL FEATURES
Tense swelling
Excessive pain - pain on passive movements
Numbness -e.g. anterior compt. first toe web (deep peroneal N )
Do not look for absent distal pulse – late

TREATMENT
Recognize
Reduce intracomparmental pressure
Remove bandages and cast
Keep limb elevated
Fasciotomy

Tense swollen limb with
Severe pain on passive movements
Neurological deficit
FASCIOTOMY

TREATMENT

FASCIOTOMY
Principles
Long extensile incisions
Release all fascial compartments
Preserve neurovascular structures
Debride necrotic tissues

COMMONLY DONE FASCIOTOMIES
Leg
Forearm
Hand
Thigh
Foot
Arm

LEG FASCIOTOMY

LEG FASCIOTOMY

SINGLE INCISION FASCIOTOMY

SINGLE INCISION FASCIOTOMY

SINGLE INCISION FASCIOTOMY

FOREARM COMPARTMENTS

FOREARM FASCIOTOMY

THIGH FASCIOTOMY

THIGH FASCIOTOMY

Foot compartments
nine compartments:
1. medial
2. superficial
3. lateral
4. adductor
5-8. four interossei
9. calcaneal -
contains the
quadratus plantae

FOOT FASCIOTOMY

FOOT FASCIOTOMY
Medial incision

Hand
Compartment
s
10 fascial compartments
4 dorsal interossei
3 palmar interossei
Thenar muscles
Adducto r pollicis
Hypothena r muscles

HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release

HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release

ARM FASCIOTOMY
15-cm skin incision over the medial
intermuscular septum

Closure Techniques
Delayed Primary Closure
Shoelace Technique
Vacuum Assisted Closure
Skin Grafting

If fasciotomy is not done
on time
Limb loss
Useless limb

Thank You