![]() ![]() Male patients, younger patients, patients with depression, and patients with deep posterior compartment involvement may serve to benefit more with fasciotomies for treatment of CECS.įoot and Ankle Ability Measure (FAAM) chronic exertional compartment syndrome (CECS) operative patient outcomes visual analog scale (VAS). Multiple linear regression analysis revealed deep posterior compartment involvement, younger age, a history of depression, and male sex to be significant independent predictors of enhanced improvement after fasciotomy.įasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater functional improvement. Patients had a mean ± SD improvement in FAAM-Sports of 40.4 ± 22.3 points ( P < 0.001), improvement in FAAM-Sports SANE of 57.3 ± 31.6 points ( P < 0.001), and reduction of VAS pain of 56.4 ± 31.8 points ( P < 0.001). Generalized multiple linear regression analyses was performed to determine independent predictors of functional and pain improvement.Ī total of 61 patients (58% response rate) who underwent 65 procedures were included in this study, with postoperative outcome measures obtained at mean duration of 57.9 months (range, 12-115 months) after surgery. The primary outcomes of change in FAAM-Sports, FAAM-Sports SANE, and VAS during sporting activities were calculated by taking the difference of post- and preoperative scores. Outcome of a specific compartment fasciotomy versus a complete compartment fasciotomy of the leg in one patient with bilateral anterior chronic exertional. Pre- and postoperative measures of Foot and Ankle Ability Measure-Sports subscale (FAAM-Sports), FAAM-Sports Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected at a minimum of 12 months postoperatively. ![]() Specific patient variables will lead to enhanced functional improvement after fasciotomy for CECS of the lower extremity.Ī review of patients undergoing fasciotomy of the lower extremity for treatment of CECS by a single surgeon from 2009 to 2017 was performed. However, not all patients have demonstrated the same level of symptom improvement. This can help reduce the size of the defect to be covered.Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating chronic exertional compartment syndrome (CECS). Careful use of elastic retention sutures (elastic vessel loop woven through skin staples) can help counteract skin contraction, and be tightened progressively as swelling resolves. This is only permissible if it can be achieved without any skin tension it is inadvisable in smokers, who have impaired capacity for soft-tissue healing.įasciotomy wound edges tend to retract and become difficult to close. It is tempting to the surgeon to try early secondary skin suture, rather than skin-graft coverage, once the swelling has subsided. The simplest and safest technique is to cover the healthy soft-tissue defect with a split skin graft: at a later date, when the limb contours have returned to normal, the grafted area can be excised and secondary skin closure performed without tension. Once any skeletal injury is under control, the fasciotomy wound(s) healthy and the swelling of the soft tissues has sufficiently regressed, consideration must be given to achieving skin coverage. Reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. An arterial injury may cause compartmental tissue ischemia.Muscle tolerates short periods of hypoxia, but after a few hours, progressive necrosis begins.(MPP has also been called "Delta P", to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure. The diagnosis was right lower leg exertional compartment syndrome, status-post fasciotomy with residual muscle weakness and pain status-post healed right tibia/fibula stress fracture and right lower leg scar.if diastolic arterial pressure is not more than 30 mm Hg above tissue pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue.When tissue pressure approaches the diastolic pressure, capillary blood flow ceases. The capillary filling pressure is essentially diastolic arterial pressure. ![]() This critical level is the tissue pressure which collapses the capillary bed and prevents low-pressure blood flow through the capillaries and into the venous drainage. Compartment syndrome occurs when the pressure within a closed osteo-fascial muscle compartment rises above a critical level.
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