Treatment of compartment syndrome: transverse fasciotomy as an adjunct to longitudinal dermatofasciotomy: an in vitro study.

摘要

OBJECTIVE: This study describes a previously unpublished technique for compartment release that combines adjunctive transverse fasciotomies with a limited longitudinal dermatofasciotomy and compares its efficacy with a standard extensile longitudinal dermatofasciotomy. DESIGN: Limited 10-cm longitudinal dermatofasciotomies were performed bilaterally on 14 cadaveric specimens (28 legs). Next, we performed transverse fasciotomies on 1 limb and performed extensions of the longitudinal incision on the contralateral limb. Subsequent changes in compartment pressures were recorded after each release. Two-tailed paired and unpaired Student t tests were performed for statistical analysis with significance set at P < 0.05. SETTING: Anatomy laboratory. RESULTS: After a 10-cm longitudinal dermatofasciotomy, the average compartment pressure was 17 +/- 7.1 mm Hg proximally and 15.5 +/- 7.4 mm Hg distally. With an extensile 16-cm longitudinal incision, a significant decrease in compartment pressure was seen both proximally (6.5 +/- 3.1 mm Hg) and distally (4.7 +/- 4.7 mm Hg). With adjunctive transverse fasciotomies, a significant reduction in compartment pressure also was observed proximally (6.9 +/- 6.1 mm Hg) and distally (6.1 +/- 5.4 mm Hg). There was no statistically significant difference in compartment pressures between an extensile 16-cm incision and 10-cm incision combined with transverse fasciotomies both proximally and distally (P = 0.84 and P = 0.5, respectively). CONCLUSIONS: A combined approach of transverse fasciotomies with a limited longitudinal dermatofasciotomy in this in vitro compartment syndrome study is as effective as a standard 16-cm longitudinal release in the anterior compartment of this cadaveric leg model.