The document discusses compartment syndrome, which results from increased intra-compartment pressure leading to reduced organ perfusion and potential muscle contractures if untreated. It outlines the causes, clinical features, and surgical treatment options, particularly fasciotomy, which involves making incisions to relieve pressure. Key principles include preserving neurovascular structures and addressing necrotic tissues, with specific approaches for various anatomical compartments.

1. Dr. Joel Arudchelvam
ConsultantVascular andTransplant Surgeon
Teaching Hospital Anuradhapura

2. COMPARTMENT SYNDROME
Reduced organ perfusion due to increased
intra compartment pressure.
 Compartment Perfusion Pressure (CPP)
 Mean Arterial Pressure (MAP)
 Intra Compartmental Pressure (ICP)
CPP = MAP – ICP

3. HISTORY
 Richard von Volkmann[1](1881)
 Described irreversible contractures of the muscles
because of ischemic processes
 Hildebrand (1906)
 first to suggest that elevated tissue pressure may be
related to ischemic contracture
 Murphy (1914)
 First to suggest that Fasciotomy might prevent the
contracture.
Volkmann R. Die ischaemischen Muskellahmungen and Kontrakturen. Zentralbl Chir. 1881;8:801–3

4. Can occur in any enclosed space;
 Upper Arm
 Forearm
 Hand
 Thigh
 Leg
 Foot
 Abdomen
 Chest
 Cranial cavity
WHERE CAN IT
OCCUR

5. CAUSES OF COMPARTMENT
SYNDROME
 Fracture s and haematoma
 Crush injuries
 Ischemia / Reperfusion
 Tight bandages
 Burns Eschar
 Tourniquet

6. CLINICAL FEATURES
 Tense swelling
 Excessive pain - pain on passive movements
 Numbness -e.g. anterior compt. first toe web (deep peroneal N )
 Do not look for absent distal pulse – late

7. TREATMENT
Recognize
Reduce intracomparmental pressure
Remove bandages and cast
Keep limb elevated
Fasciotomy

8.  Tense swollen limb with
 Severe pain on passive movements
 Neurological deficit
FASCIOTOMY

9. TREATMENT

10. FASCIOTOMY
 Principles
 Long extensile incisions
 Release all fascial compartments
 Preserve neurovascular structures
 Debride necrotic tissues

11. COMMONLY DONE FASCIOTOMIES
 Leg
 Forearm
 Hand
 Thigh
 Foot
 Arm

12. LEG FASCIOTOMY

13. LEG FASCIOTOMY

14. SINGLE INCISION FASCIOTOMY

15. SINGLE INCISION FASCIOTOMY

16. SINGLE INCISION FASCIOTOMY

17. FOREARM COMPARTMENTS

18. FOREARM FASCIOTOMY

19. THIGH FASCIOTOMY

20. THIGH FASCIOTOMY

21. Foot compartments
nine compartments:
1. medial
2. superficial
3. lateral
4. adductor
5-8. four interossei
9. calcaneal -
contains the
quadratus plantae

22. FOOT FASCIOTOMY

23. FOOT FASCIOTOMY
Medial incision

24. Hand
Compartment
s
 10 fascial compartments
 4 dorsal interossei
 3 palmar interossei
 Thenar muscles
 Adducto r pollicis
 Hypothena r muscles

25. HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release

26. HAND FASCIOTOMY
•Two longitudinal incisions over 2nd and 4th metacarpals - Palmar /dorsal interossei
•Longitudinal incision radial side of 1st metacarpal - thenar compartment
•Longitudinal incision over ulnar side of 5th metacarpal - hypothenar compartment
•Carpal tunnel release

27. ARM FASCIOTOMY
15-cm skin incision over the medial
intermuscular septum

28. Closure Techniques
 Delayed Primary Closure
 Shoelace Technique
 Vacuum Assisted Closure
 Skin Grafting

29. If fasciotomy is not done
on time
 Limb loss
 Useless limb

30. Thank You