COMPARTMENTS OF LEG ORTHOBULLETS SKIN
Careful use of elastic retention sutures (elastic vessel loop woven through skin staples) can help to counteract skin contraction, and be tightened progressively as swelling resolves. This is only permissible if it can be achieved without any skin tension it is inadvisable in smokers, who have impaired capacity for soft-tissue healing.įasciotomy wounds tend to contract and become difficult to close. It is tempting to the surgeon to try early secondary skin suture, rather than skin-graft coverage, once the swelling has subsided. At a later date, when the limb contours have returned to normal, the grafted area can be excised and secondary skin closure performed without tension. The simplest and safest technique is to cover the healthy soft-tissue defect with a split skin graft.
Once any skeletal injury is under control, the fasciotomy wound(s) healthy and the swelling of the soft tissues has sufficiently regressed, consideration must be given to achieving skin coverage. Reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. Muscle tolerates short periods of hypoxia, but after a few hours, progressive necrosis begins.Īn arterial injury may cause compartmental tissue ischemia. (MPP has also been called ΔP, to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure. if diastolic arterial pressure is less than 30 mm Hg above tissue pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue.The compartment syndrome of the foot requires. When tissue pressure approaches the diastolic pressure, capillary blood flow ceases. Fasciotomy of the lower leg can be performed either by one lateral incision or by medial and lateral incisions. The capillary filling pressure is essentially diastolic arterial pressure. This critical level is that tissue pressure which collapses the capillary bed and prevents low-pressure blood flow through the capillaries and into the venous drainage. Compartment syndrome occurs when the pressure within a closed osteofascial muscle compartment rises above a critical level.
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