Document Detail


Pathology and diagnostic options of lower limb compartment syndrome.
MedLine Citation:
PMID:  19136736     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The indication of surgical treatment in lower limb compartment syndrome mostly depends on the clinical signs which can be often uncertain, resulting in delayed insufficient intervention. AIM: The aim of the study was to evaluate the progression of compartment syndrome by measuring of intracompartmental pressure and monitoring of decreased tissular oxygenation, indicating an insufficient secondary microcirculation. MATERIALS AND METHODS: 16 patients were examined in our study (12 males, 4 females, mean age: 62.7+/-9.5 years), who underwent acute lower limb revascularization surgery for a critical (lasting more than 4 hours) limb ischemia. The indications were: 5 iliac artery embolizations and 11 femoral artery occlusions. After revascularization, on the second postoperative day, we detected significant lower limb edema and swelling of several grade. To monitor the elevated intracompartmental pressure (ICP) and to evaluate the extremital circulation, we used KODIAG pressure meter and the tissular oxygen saturation (StO2) was measured by near-infrared-spectroscopy. RESULTS: In 12 cases the ICP exceeded the critical 40 mmHg. In these patients the average StO2 was 50-53%, in spite of complete recanalization. In these cases we made urgent, semi-open fasciotomy. In 4 cases, where the clinical aspect showed compartment syndrome, the measured parameters did not indicate a surgical intervention (ICP: 25-35 mmHg, StO2: around normal). SUMMARY: A novel approach in our examination is that, besides empirical therapeutic guidelines generally applied in clinical practice, we established an objective, parameter-based ("evidence based medicine") surgical indication strategy for the lower limb compartment syndrome. Our parameter results produced by the above pressure and saturation measurements help the clinicians to decide between conservative and operative treatment of the disease.
Authors:
E Arató; M Kürthy; L Sínay; G Kasza; G Menyhei; S Masoud; A Bertalan; Zs Verzár; L Kollár; E Roth; G Jancsó
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical hemorheology and microcirculation     Volume:  41     ISSN:  1386-0291     ISO Abbreviation:  Clin. Hemorheol. Microcirc.     Publication Date:  2009  
Date Detail:
Created Date:  2009-01-12     Completed Date:  2009-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9709206     Medline TA:  Clin Hemorheol Microcirc     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  IM    
Affiliation:
Department of General and Vascular Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary. aratoendre@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Cohort Studies
Compartment Syndromes / diagnosis*,  physiopathology*,  surgery
Fascia / surgery
Female
Humans
Ischemia / physiopathology
Lower Extremity / physiopathology*,  surgery
Male
Middle Aged
Oxidative Stress

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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