Preventive decompression of muscle compartments

After severe soft tissue injury, excessive swelling may be expected in the affected muscle compartments. This is due to local hemorrhage as well as increased capillary permeability. Since the fascial structures surrounding each compartment are rigid, an increase in compartmental volume leads to increased pressure, which eventually results in shutdown of capillary perfusion with subsequent necrosis. In the polytraumatized patient, this development is enhanced when arterial pressure is decreased or (local) venous pressure is increased. In addition, while elevation of the affected extremity decreases edema, traction on the affected extremity may increase compartmental pressure. Early clinical signs and symptoms of a developing compartment syndrome include paresthesias, although they may go unnoticed in the polytraumatized patient who is unable to communicate.

Compartment pressures can be measured using a specialized instrument or an arterial line set-up. Pressures above 20 mmHg require close observation, and pressures over 30 mmHg require fasciotomy. A knowledge of the various compartments is necessary; for example, all four compartments of the lower leg must be measured and surgically addressed if necessary.

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