Vascular: Compartment Syndrome

Pathology

• Definition: Increased Tissue Pressures Cause Neurovascular Damage
• Pathophysiology:
  • Increased Pressure Obstructs Venous Outflow & Then Arterial Inflow
  • Causes a Reduced Capillary Perfusion Pressure
  • Muscle Necrosis Occurs from Inside-Out

General Concepts

• Can Occur in Any Compartment
  • Including Buttock (Obese After Prolonged Anesthesia), Shoulder & Hands
• Most Common in Calf or Forearm
  • Surrounding Fascia is Less Elastic than Other Muscle Compartments

Compartments

• *See Vascular: Compartment Anatomy

Causes

• Most Common Causes: Trauma or Reperfusion Injury
• Increased Compartment Mass
  • Ischemic Reperfusion Injury
    • *Ischemia Alone Does Not Cause Increased Pressure
    • *See Vascular: Peripheral Revascularization
  • Bleeding (Fracture/Hemophilia/Anticoagulation)
  • Crush Injury
  • Venous Thromboembolism
  • High-Voltage Electrical Injury
  • Shock
  • IV Infiltration
  • IV Drug Infiltration
• Decreased Compartment Size
  • Tight Dressings
  • Casting
  • Eschars from Burns
  • Military Antishock Garments

Symptoms (6 P’s)

• Pain – First Sign
• Paresthesia (Pins & Needles Sensation)
• Paresis (Weakness) or Paralysis (Unable to Move)
• Pallor (Pale Color)
• Poikilothermic (Cold)
• Pulseless – Late Sign

Diagnosis

• Dx: Primarily Based on Physical Exam
• Measure Compartment Pressures
  • Compartment Pressure > 30 mmHg
  • Or Gradient Between Diastolic & Compartment Pressure < 30 mmHg

Treatment

• Emergent Fasciotomy
• *See Vascular: Fasciotomy

Prophylactic Fasciotomy Indications

• Ischemia > 6 Hours
• High Risk Injury
• Significant Crush Injury