Compartment Syndrome McMaster Universitys （筋膜室综合征麦克马斯特大学的）.pdfVIP

Compartment Syndrome Recognition and Care Jeffrey Kwee, PGY-2 August 16, 2005 Compartment Syndrome ♦Definition ♦Etiology ♦Pathophysiology ♦Recognition ♦Diagnosis ♦Treatment Compartment Syndrome ♦Definition – An area of the body where the interstitial pressure exceeds the capillary perfusion pressure ♦Etiology – Increase in mass in a fixed volume compartment • Edema, venous obstruction due to fracture, burns, inflammation, tight surgical closure, fluid infiltration, reperfusion after temporary ischemia, snake envenomation electrical burns – Extrinsic pressure • Circumferential burns, tight casting • Crush syndrome (similar but different) Pathophysiology – Micro-vascular collapse at the level of the venous capilliaries initially – Normal interstitial pressures around 4 mmHg – Normal capilliary perfusion pressures is around 30mm Hg – As the interstitial pressure exceeds capilliary pressure you get shunting within the compartment – Ischemia of the muscle • Leading to inflammation and leakage of fluid – Poor drainage as venous pressure is exceeded – More edema, extravasization leading to increased pressures – ‘vicious circle’ Vicious Cycle Increased Pressure Edema Venous obstruction Leaky Vessels Shunting Ischemia Necrosis Compartment Syndrome ♦The result – If left unchecked for more than just a few hours, irreversible damage will occur – Massive tissue necrosis, usually muscle, nerves in that area – If in a fascial compartment, nerves running through are affected – If large vessel arterial compromise – loss of distal circulation – loss of