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Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned
BACKGROUND: Prompt diagnosis and decompression of acute lower extremity compartment syndrome (LECS) in the multisystem injured patient is essential to avoid the devastating complications of progressive tissue necrosis and amputation. Despite collaborative trauma and orthopedic management of these di...
Autores principales: | , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2009
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704180/ https://www.ncbi.nlm.nih.gov/pubmed/19527510 http://dx.doi.org/10.1186/1754-9493-3-11 |
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author | Kashuk, Jeffry L Moore, Ernest E Pinski, Sarah Johnson, Jeffrey L Moore, John B Morgan, Steven Cothren, Clay C Smith, Wade |
author_facet | Kashuk, Jeffry L Moore, Ernest E Pinski, Sarah Johnson, Jeffrey L Moore, John B Morgan, Steven Cothren, Clay C Smith, Wade |
author_sort | Kashuk, Jeffry L |
collection | PubMed |
description | BACKGROUND: Prompt diagnosis and decompression of acute lower extremity compartment syndrome (LECS) in the multisystem injured patient is essential to avoid the devastating complications of progressive tissue necrosis and amputation. Despite collaborative trauma and orthopedic management of these difficult cases, significant delays in diagnosis and treatment occur. Periodic system review of our trauma and orthopedic data for complications of LECS led us to hypothesize that delayed diagnosis and limb loss were potentially preventable events in our trauma center. SETTING: Academic level 1 trauma center. METHODS: We performed a prospective review of our trauma registry for all cases of LECS over a 7 year period (2/98–10/2005). Variables reviewed included demographics, injury patterns, tissue necrosis, amputation and mortality. RESULTS: Eighty-three (10 female, 73 male) cases were reviewed. Mean age = 33.3 years (range 1–78). Mean ISS = 19.4, GCS = 12.5. Five (6.0%) had amputations; 7 (8.4%) died. Fractures occurred in 68.7% (n = 57), and vascular injuries were present in 38.6% (n = 32). In 7 patients (8.4%), a delayed compartment release resulted in muscle necrosis requiring multiple debridements, subsequent wound closure problems, and long term disability. Of note, none of these patients had prior compartment pressure measurements. Furthermore, 6 patients (7%) had superficial peroneal nerve transections as complications of their fasciotomy. CONCLUSION: In the multisystem injured patient, LECS remains a major diagnostic and treatment challenge with significant risks of limb loss as well as complications from decompressive fasciotomy. These data underscore the importance of routine surveillance for LECS. In addition, a thorough knowledge of regional anatomy is essential to avoid technical morbidity. |
format | Text |
id | pubmed-2704180 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-27041802009-07-01 Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned Kashuk, Jeffry L Moore, Ernest E Pinski, Sarah Johnson, Jeffrey L Moore, John B Morgan, Steven Cothren, Clay C Smith, Wade Patient Saf Surg Research BACKGROUND: Prompt diagnosis and decompression of acute lower extremity compartment syndrome (LECS) in the multisystem injured patient is essential to avoid the devastating complications of progressive tissue necrosis and amputation. Despite collaborative trauma and orthopedic management of these difficult cases, significant delays in diagnosis and treatment occur. Periodic system review of our trauma and orthopedic data for complications of LECS led us to hypothesize that delayed diagnosis and limb loss were potentially preventable events in our trauma center. SETTING: Academic level 1 trauma center. METHODS: We performed a prospective review of our trauma registry for all cases of LECS over a 7 year period (2/98–10/2005). Variables reviewed included demographics, injury patterns, tissue necrosis, amputation and mortality. RESULTS: Eighty-three (10 female, 73 male) cases were reviewed. Mean age = 33.3 years (range 1–78). Mean ISS = 19.4, GCS = 12.5. Five (6.0%) had amputations; 7 (8.4%) died. Fractures occurred in 68.7% (n = 57), and vascular injuries were present in 38.6% (n = 32). In 7 patients (8.4%), a delayed compartment release resulted in muscle necrosis requiring multiple debridements, subsequent wound closure problems, and long term disability. Of note, none of these patients had prior compartment pressure measurements. Furthermore, 6 patients (7%) had superficial peroneal nerve transections as complications of their fasciotomy. CONCLUSION: In the multisystem injured patient, LECS remains a major diagnostic and treatment challenge with significant risks of limb loss as well as complications from decompressive fasciotomy. These data underscore the importance of routine surveillance for LECS. In addition, a thorough knowledge of regional anatomy is essential to avoid technical morbidity. BioMed Central 2009-06-15 /pmc/articles/PMC2704180/ /pubmed/19527510 http://dx.doi.org/10.1186/1754-9493-3-11 Text en Copyright © 2009 Kashuk et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Kashuk, Jeffry L Moore, Ernest E Pinski, Sarah Johnson, Jeffrey L Moore, John B Morgan, Steven Cothren, Clay C Smith, Wade Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title | Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title_full | Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title_fullStr | Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title_full_unstemmed | Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title_short | Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
title_sort | lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704180/ https://www.ncbi.nlm.nih.gov/pubmed/19527510 http://dx.doi.org/10.1186/1754-9493-3-11 |
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