Compartment syndrome

Compartment syndrome is compression of the nerves, muscles and blood vessels inside a closed space-compartment of the body. This phenomenon leads to cell death by lack of oxygenation, blood vessels are compressed by high pressure in the compartment. Compartment syndrome most commonly involve the forearm and leg. Form can be divided into acute, subacute and chronic.
There are five signs of compartment syndrome-associated excessive pain, paresthesia, pallor, paralysis, lack of pulse and / or poikilotermia. Any condition that causes increased compartment content or reduce its volume could lead to development of acute compartment syndrome. When the capillary pressure is high single is compromised. Soft tissue edema in the compartment pressure increases venous and lymphatic drainage intracompartimentala compress the injured area. High pressure and compromise drive a vicious cycle leading to arteriolar perfusion ischemia. Untreated muscle and nerve ischemia leads to irreversible destruction and tissue death in the compartment.
Acute compartment syndrome is a medical emergency requiring immediate surgery, incisions to allow pressure to return to normal.Subacute syndrome usually require urgent surgical treatment similar to acute form. Sidnromul chronic compartment can be treated surgically or conservatively. This includes rest, anti-inflammatory limb lifting and manual decompression. In cases of persistent symptoms of the condition can be treated by a surgical procedure, incisions subcutaneous or open incisions. If left untreated can develop into acute syndrome. A possible complication of surgery for chronic compartment syndrome may be chronic venous insufficiency. Hyperbaric oxygen therapy has proved useful in the therapy for traumatic ischemia.Failure to remove pressure compartment and cause tissue necrosis, capillary perfusion will decrease, leading to increased hypoxia. Volkmann contracture may occur in the affected limb. Left untreated compartment syndrome leads to more severe conditions including rhabdomyolysis and renal failure, leading to potential death.
Causes and pathogenesis:
Since the connective tissue that defines the compartment does not spread a small amount of bleeding or swelling of the chamber can cause an immediate increase in pressure. Common causes of compartment syndrome include tibial or forearm fractures, after ischemic reperfusion injury, hemorrhage, vascular puncture, intravenous injection of drugs, prolonged limb compression, crush injuries and burns.
Another possible cause may be the use of creatine monohydrate.Compartment syndrome can occur after surgery in the lithotomy position in which legs are lifted patient for long periods. When the syndrome is caused by repetitive use of muscles as a cyclist is known as chronic compartment syndrome. This is not an emergency but the loss of circulation can cause temporary or permanent damage to local nerves and muscles.
Interstitial pressure is almost zero average contracted muscles. If this pressure is increased above 30 mmHg in the small vessels become compressed, leading to reduction of tissue blood flow, ischemia and pain. Of particular importance is the difference between compartment pressure and diastolic blood pressure, diastolic blood pressure when compartment pressure exceeds by more than 30 mmHg is considered an emergency. Untreated compartment syndrome leads to ischemia of the muscles and nerves and eventually irreversible damage and death of tissue in the compartment.
Funtion deficits induced tissue perfusion pressure and therefore decrease the degree of pressure that it can tolerate a Member State depends on the rise, blood pressure, bleeding and arterial occlusion. In addition to local morbidity and muscle necrosis caused by tissue ischemia, cellular destruction and alterations in muscle membrane leads to release of myoglobin into the circulation. This circulating myoglobin cause kidney damage.Advanced compartment syndrome can cause rhabdomyolysis and compartment syndrome reverse cause rhabdomyolysis. Mortality of patients is usually due to renal failure or sepsis in wound therapy difficult.
Muscle mass increases by 20% during exercise and contribute to intracompartimentale pressure transient. Repetitive muscle contraction alone can increase intramuscular pressure to levels that can lead to transient ischemia. Chronic compartment Sidnromul occurs when pressure remains high between successive contractions and prevent blood flow. As arterial blood pressure by relaxing muscle increases and decreases patient accuses cramps. Anterior and lateral compartments of the leg are usually affected, and deep posterior compartments are rarely involved.