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A.Zenelaj, M.Brati, *V.Zenelaj
COMPARTMENT SYNDROME AND ITS TREATMENT IN ARTERIAL TRAUMA
Department of Surgery. Central Military University Hospital.
*Department of General Medicine.”Mother Teresa” University Hospital.
Introduction: In each case with important peripheral vascular injury one of the crucial problems to be solved is the installation of the compartment syndrome.
Material and methods: From August 1999 till March 2005 we treated 77 patients
with important arterial injuries of the limbs. The range in age was from 13 to
65 years old. In 62 patients the injury was in lower limbs, in 15 the injury was
in upper ones. The injuries were causalities of shotguns in 55 cases, knives and
other sharp objects in 17 cases, road incidents in 4 cases and iatrogenic 2
We performed fasciotomy in 29 cases. All of them in the legs. In the cases we
performed fasciotomy complexity of trauma was 93%. The rest of cases had a
complexity of 15 % . Mean time of addmition in our department from the moment of
trauma was 16.5 hours in fasciotomy group and 6. 5 hours in non fasciotomy
In the cases with fasciotomy revascularization procedures have been performed in
85% of patients. Whereas in the cases without fasciotomy revascularization
procedures were performed in 100 % of cases.
Results: In the cases treated with fasciotomy 26 patients did well versus 32 in
non fasciotomy group. Amputation in different levels were performed in three
cases in fasciotomy group and one in the other group. Neuropathy was installed
in 2 patients with fasciotomy versus 1 patient without fasciotomy. Muscular
necrosis suffered 3 patients with fasciotomy. Mean duration of stay in hospital
was 19 days in the group with fasciotomy and 10 days in the group without.
Conclusions: Fasciotomy should be performed as soon as possible in all cases
where a compartment syndrome is installed
Ключевые слова: peripheral vascular injury, crucial problems, compartment syndrome
Trauma is one of major causes of death in our hospital. The patients generally
belong the age till fourth decade of life . They had penetrated and blunt
vascular trauma injuries. In developed countries the causes of injury usually
are road accidents and invasive diagnostic and therapeutic procedures [20,21,22]
In our hospital in 92 % of patients the injury is been due to aggression of the
person ; 5 % are due to road accidents and 3 % iatrogenic ones . Most of the
patients have been injured by military weapons , which have high kinetic energy
causing massive damage of tissues [17,18,19] . In all cases that a major
vascular injury is present the surgical team should be alert of compartment
syndrome [2,3,11] .
Material and Methods:
We studied 77 patients with vascular limb injuries during August 1999 – March
2005 .In the study are included patients with major vascular injuries of the
limbs and are excluded those with not important vascular injuries . In other
words those with injuries that do not threaten the limb viability .
In our cases 72 were males , 5 females . The age of patients rated 13 - 65 years
old [ medium 28,9 years old ] . In 62 patients the injury is been in inferior
limbs and 15 in superior ones .
The cause of injury was [Graphic 1]:
a - 54 cases by shot guns.
b - 17 cases by sharp weapons.
c - 4 cases by road accidents.
d - 2 cases iatrogenic injuries.
We performed fasciotomy in 29 cases. All of them belong to inferior limbs.
Fasciotomy was done when compartment syndrome was installed [1, 3,4]. 33
patients were treated without fasciotomy , 5 of them were complex trauma.
In the cases where fasciotomy was done the injury belonged to the artery alone [
2 cases ] ; artery and vein [ 20 cases ] ; vascular injury and fracture [ 7
cases ] .
The study has a retrospective analytic character .We compared:
1 – The final result.
2 – Complications.
3 – Complexity.
4 – Duration of stay in hospital.
The statistical test used is of Mann – Whitney.
An important component in vascular trauma is the complexity of injury [15,16] .
In 38 , 9 % of our cases the injury belonged the arterial system . In 61, 1 %
there was combined injuries. From them 72 , 3 % was injured the arterial and
venous systems . In 21, 3 % there was an artery and a bone fracture. In 6 , 4 %
the injury belonged to arterial and muscle –skeletal systems [See graphic 2] .
If we will evaluate cases treated with and without fasciotomy we ’ ll see that
cases treated with fasciotomy stayed longer in hospital than those treated
without. From the other side if will compare the arrival hospital time , the
complexity of injury and the kind of surgical procedure performed , the
definition will come that in cases treated with fasciotomy were more complex ,
they reached late in the trained medical centre and in 85 % of revascularization
surgical intervention was performed [See Graphic 2] .
In the cases where fasciotomy is been done our surgical choice was lateral and
medial fasciotomy with long incisions [9,10,11] [See Figures 1 and 2] .
In the table 1 there are indicated results in both groups . With not favorable
result we considered each case were any kind of amputation was performed .
In all cases with a muscle necrosis , the first signs of ischemia and necrosis
appeared in the anterior muscle compartment of lower limbs . In one of the
amputated case the revascularization procedure was done 14 hours after the event
. In other 3 cases the amputation is performed after fasciotomy was done .
Fasciotomy closure was done in a period of time varied 5 - 40 days . This
happened due to degree of infection and muscle necrosis .
The median hospital stay for patients treated with fasciotomy was 19 days . In
the other group the median hospital stay was 10 days .
We used Mann - Whitney statistical test. Based on the test there was a
significant difference [ p < 0.05 ] belonging the complexity of trauma in the
fasciotomy and without fasciotomy groups .
There by the amputation rate in the fasciotomy group should have been
statistically significant . In fact it resulted that the amputation rate between
both groups was comparable .
Also significant difference was between groups belonging duration of stay in
hospital . We saw that in the amputated cases there were complex injuries , the
arrival time in hospital was late [ 20 - 36 hours ] , surgical procedure was
ligature of the artery .
In the results optic we think that fasciotomy is very important in the cases
where it is indicated , independently from the fact it usually is followed by
longer hospital stay [12,13,14] .
According to muscle necrosis and neuropathy we believe that they are not
complications of fasciotomy procedure , but results of delay in performing
1 – Fasciotomy is as well important as the revascularization procedure is ,
making it more effective and reducing sequels of compartment syndrome .
2 - Time , complexity and anatomic region that a peripheral arterial trauma is
associated , are important predictor factors in the development of compartment
3 - When compartment syndrome is installed long incisions should be done .
4 - The possibility of development of compartment syndrome in upper limbs is
less than in the inferior ones.
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