Compartment syndrome - Treatment

Medical therapy:It will place the affected limb at heart level. Closure is contraindicated because it decreases blood flow and arterial pressure colabeaza arteriovenous aggravating ischemia.Reduce intracompartimentale by introducing a plastic valve that reduces pressure by 30%. Bivalve devices produce an additional reduction of 355 pressure.Hypoperfusion should be corrected with administration of crystalloids and blood products. Mannitol can reduce pressure and relieve compartment reperfusion injury. Vasodilator drugs or simpaticoblocantele seem to be ineffective in the treatment of compartment syndrome because this condition is already present local maximal vasodilation.
Hyperbaric Oxygen Therapy:This therapy promotes vasoconstriction, which reduces swelling and edemulo hiperoxica and improve local blood flow and oxygenation. Also increases tissue oxygen tension and improves the survival of marginally viable tissue. At the time of surgical debridarii hyperbaric oxygen pretreatment tissue demarcation nonviabil help. The best results are obtained when therapy is started early. Twice daily treatment with 2.0 atmospheres absolute for 120 minutes is recommended for 7 days with frequent examination of the affected area.
Surgical therapy:Definitive surgical therapy for compartment syndrome is urgent incisions with secondary orthopedic reduction or stabilization of fractures and vascular repair if necessary. The purpose of decompression is to restore muscle perfusion in 6 hours. Although several surgical techniques have been described dual incisions in the leg incision is treated most commonly used. To minimize soft tissue injuries, especially if a fracture some surgeons prefer a single incision. Whether adequate exposure to approach the whole compartment used previously and fibula nerve is especially serious.Fasciotomiei Features:-Should be long enough, since the end of the fibular malleolus malleolus external and internal muscle internal space, if not the uncompressed uncompresses will complete muscle hernia and will become ischemic after a period-Spaces must open all muscleWill evacuate the hematoma, lavage, surgical debridementWill only cover the complete elimination of symptoms after a few days of treatment, otherwise the process will returnRecommended the closure or suture the graft secondary and not primary suture.
Compresses antibiotics can be used if present a burst fractures open, especially with loss of bone. Rubber bands are used on skin to prevent excessive skin retraction. Panseaza wound is open. You will be debridat in 1-3 days if necessary or will Ichidai skin.Prophylactic antibiotics are helpful. Removal of sutures takes place 10-14 days if the wound is closed. Patients may require skin grafting or skin dermoplastie traction if the defect is large.
Prognosis:Acute compartment syndrome can have disastrous trend. Muscle better tolerate 4 hours of ischemia, but after 8:00 lesions are often irreversible. If the incisions are made in the first 25-30 hours after onset prognosis is good. When treatment is delayed, may return residual muscle function at all. Despite early fasciotomiei agressor and nearly 20% of patients may remain persistent sensory or motor deficits in one year supervision.Transferele tendon and foot stabilization may be indicated for the treatment of late syndrome but most patients develop muscle contracture and scar anthers to prevent foot fall. But a rod is indicated for the first few months after the onset until the appearance of fibrosis syndrome. Most athletes accused of gastrocnemius and Soleus persistent weakness due to loss of support by fascial incisions.