RESUMEN
Breast augmentation is the most commonly performed aesthetic surgery procedure in women worldwide. The use of the subfascial plane has been suggested to decrease the incidence of capsular contracture compared with the subglandular plane, while simultaneously avoiding the complication of animation deformity in the subpectoral plane. The aim of this systematic review and meta-analysis was to compare the adverse outcomes of subfascial vs subglandular planes in breast augmentation. This review was registered a priori on OSF (https://osf.io/pm92e/). A search from inception to June 2023 was performed on MEDLINE, Embase, and CENTRAL. A hand search was also performed. All randomized and comparative cohort studies that assessed the use of the subfascial plane for breast augmentation were included. Outcomes evaluated included the incidences of seroma, hematoma, infection, rippling, capsular contracture, and revision surgery. Ten studies were included in this systematic review. Three randomized controlled trials and 7 comparative cohort studies were used for quantitative synthesis. There was a significant difference favoring subfascial compared with subglandular planes in the incidence of hematoma, rippling, and capsular contracture. All included studies had a high risk of bias. The current evidence suggests that the subfascial plane for breast augmentation decreases the risk of capsular contracture, hematoma, and rippling compared with the subglandular plane. Further randomized evidence with high methodological rigor is still required to validate these findings.
Asunto(s)
Implantación de Mama , Complicaciones Posoperatorias , Humanos , Femenino , Implantación de Mama/métodos , Implantación de Mama/efectos adversos , Implantación de Mama/instrumentación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como Asunto , Fasciotomía/métodos , Fasciotomía/efectos adversos , Contractura Capsular en Implantes/epidemiología , Contractura Capsular en Implantes/etiología , Contractura Capsular en Implantes/prevención & control , Implantes de Mama/efectos adversos , Reoperación/estadística & datos numéricos , Mamoplastia/métodos , Mamoplastia/efectos adversos , Seroma/etiología , Seroma/epidemiología , Seroma/prevención & controlRESUMEN
BACKGROUND: Bleeding during first sexual intercourse represents a significant sociocultural concern with potential implications for some couples. OBJECTIVES: The aim of this study was to introduce a novel modification to temporary and permanent hymenoplasty and evaluate both the objective and subjective success of defined techniques by assessing surgical outcomes and patient satisfaction with either temporary or permanent hymenoplasty procedures. METHODS: A retrospective study of 246 patients was conducted between 2015 and 2023. Various parameters, including age, sexual history, pregnancies, BMI, and bleeding satisfaction, were assessed. Pain at first intercourse was rated on a visual analog scale (VAS). RESULTS: The age at the time of operation was significantly lower in patients undergoing permanent hymenoplasty compared with those undergoing temporary hymenoplasty (24.0 years [interquartile range (IQR), 22.0-26.0 years] vs 27.0 years [IQR, 26.0-29.0 years]; P < .001). Patients undergoing permanent hymenoplasty reported significantly lower VAS scores at first sexual intercourse compared with those undergoing temporary hymenoplasty (4.0 [IQR, 2.0-5.0] vs 7.0 [IQR, 6.0-7.0]; P < .001]. Satisfaction rates were high in both groups, with all temporary hymenoplasty patients satisfied with duration of bleeding compared with 78.6% (110/140) of permanent hymenoplasty patients (P < .001). CONCLUSIONS: This study introduces a novel modified temporary and permanent hymenoplasty technique to the literature and provides the first video documentation for both temporary and permanent hymenoplasty procedures. Both hymenoplasty techniques are effective and reliable. However, temporary hymenoplasty is associated with a higher bleeding rate than permanent hymenoplasty, despite resulting in higher VAS scores.
Asunto(s)
Coito , Himen , Satisfacción del Paciente , Humanos , Femenino , Estudios Retrospectivos , Himen/cirugía , Adulto , Adulto Joven , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Fasciotomía/métodos , Fasciotomía/efectos adversosRESUMEN
OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. CONCLUSION: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Hipertensión Intraabdominal , Terapia de Presión Negativa para Heridas , Mallas Quirúrgicas , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Masculino , Anciano , Femenino , Terapia de Presión Negativa para Heridas/efectos adversos , Rotura de la Aorta/cirugía , Rotura de la Aorta/mortalidad , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/prevención & control , Hipertensión Intraabdominal/cirugía , Anciano de 80 o más Años , Resultado del Tratamiento , Estudios Retrospectivos , Tracción/efectos adversos , Tracción/métodos , Factores de Tiempo , Persona de Mediana Edad , Técnicas de Abdomen Abierto/efectos adversos , Factores de Riesgo , Técnicas de Cierre de Herida Abdominal/efectos adversos , Técnicas de Cierre de Herida Abdominal/instrumentación , Fasciotomía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiologíaRESUMEN
PURPOSE: The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. METHODS: In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance. RESULTS: Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L. CONCLUSIONS: ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study.
Asunto(s)
Síndromes Compartimentales , Traumatismos de la Pierna , Traumatismos de los Tejidos Blandos , Humanos , Estudios Retrospectivos , Pierna , Estudios de Casos y Controles , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Fasciotomía/efectos adversos , Factores de Riesgo , Creatina QuinasaRESUMEN
Neonatal compartment syndrome, although rare, has a classic presentation with sentinel skin findings and development of swelling, erythema, and tenderness of the affected extremity. Neonatal compartment syndrome requires prompt surgical intervention to preserve the affected limb and ensure its normal growth and development. Our patient was born at term via vaginal delivery complicated by a compound presentation involving the left upper extremity. No physical exam abnormalities were noted at birth, but she developed signs of neonatal compartment syndrome by 15 h of life. She was surgically treated at 22 h of life and recovered well. At one year of age, she has normal growth and function of the affected extremity. Our case adds to the growing literature associating neonatal compartment syndrome with a compound fetal presentation.
Asunto(s)
Síndromes Compartimentales , Recién Nacido , Embarazo , Femenino , Humanos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Parto Obstétrico/efectos adversos , Presentación en Trabajo de Parto , Fasciotomía/efectos adversosRESUMEN
BACKGROUND: Acute compartment syndrome of the upper extremity is a surgical emergency, and timely diagnosis with immediate fasciotomies is essential for the preservation of function. This retrospective study aimed to compare the complication rates of patients who underwent fasciotomy before and after 6 hours following the initial trauma. METHODS: The medical records of the patients who underwent fasciotomy for surgical treatment of ACS of the upper extremity between 2016 and 2022 were retrospectively analyzed for age, gender, dominant hand, mechanism of injury, injury level, affected compartments, associated injuries, time elapsed till fasciotomy, and complications. The patients were divided into two groups according to the timing of fasciotomy. RESULTS: A total of 32 patients underwent fasciotomies for upper extremity ACS. The mean age of patients who underwent fasciotomy ≤ 6 hours (group 1; 10 males, 7 females) and patients who underwent fasciotomy > 6 hours (group 2; 13 males, 2 females) was 31.1 and 34.8, respectively. The most common etiology was crushing injury. There was a significant difference in complication rates between group 1 (1/17) and group 2 (10/15) (p<0.001). The length of hospitalization stay in group 2 was statistically higher than in group 1 (p=0.005). CONCLUSION: Fasciotomies for ACS of the upper extremity should be performed in less than 6 hours following the initial trauma to prevent complications.
Asunto(s)
Síndromes Compartimentales , Fasciotomía , Masculino , Femenino , Humanos , Fasciotomía/efectos adversos , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Factores de Tiempo , Extremidad Superior/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaras earthquake. METHODS: An institutional database review was conducted to evaluate the results of patients who applied to our hospital's emergency department after the Kahramanmaras earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient's condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients. RESULTS: Within the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456). CONCLUSIONS: Fasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient's condition as well as the availability of the operating theatre.
Asunto(s)
Síndromes Compartimentales , Síndrome de Aplastamiento , Terremotos , Ortopedia , Humanos , Estudios Retrospectivos , Síndrome de Aplastamiento/cirugía , Síndrome de Aplastamiento/complicaciones , Fasciotomía/efectos adversos , Hospitales , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/cirugíaRESUMEN
A 52-year-old man presented with a bicondylar tibial plateau fracture and acute compartment syndrome. Continuous compartment pressure monitoring was used while the patient was treated with fasciotomies and application of an external fixator. The intraoperative pressure reading in the anterior compartment decreased from 105 mm Hg to 50 mm Hg after skin and subcutaneous tissue incision. Pressure continued to decrease to 10 mm Hg after all 4 compartments were released. The patient underwent staged open reduction and internal fixation and healed both fracture and fasciotomy incisions without complication. To our knowledge, this is the first report of continuous pressure changes during the different stages of a compartment release. Future studies could expand on use of this technology to gain information on compartment pressures during release and how single release affects pressures in other compartments. [Orthopedics. 2024;47(2):e98-e101.].
Asunto(s)
Síndromes Compartimentales , Fracturas de la Tibia , Masculino , Humanos , Persona de Mediana Edad , Fasciotomía/efectos adversos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fijación Interna de Fracturas/efectos adversos , Fijadores Externos/efectos adversos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicacionesRESUMEN
PURPOSE: Gluteal compartment syndrome (GCS) is a rare but devastating condition with a paucity of literature to help guide diagnosis and management. This study aims to identify and describe the risk factors and patient characteristics associated with GCS to facilitate early diagnosis. METHODS: This is a retrospective case series of patients undergoing gluteal compartment release between 2015 and 2022 at an academic Level I trauma center. Chart reviews were performed to extract data on patient demographics, presenting symptoms, risk factors, operative findings, and postoperative outcomes. RESULTS: 14 cases of GCS were identified. 12 (85.7%) were male, with a mean age of 39.4 ± 13 years and a mean BMI of 25.1 ± 4.1 kg/m2. 12 (85.7%) patients did not present as traumas and only 3 had ≥ 1 fracture. 9 patients reported drug use. Hemoglobin (Hgb) (11.7 ± 4 g/dL) was generally low (5 had Hgb < 10 g/dL). Creatine kinase (49,617 ± 60,068 units/L) was consistently elevated in all cases, and lactate (2.8 ± 1.6 mmol/L) was elevated in 9. 13 had non-viable muscle requiring debridement. Postoperatively, the mean ICU length of stay was 12 ± 23 days. 2 patients died during admission and all remaining patients required discharge to rehabilitation facilities. CONCLUSION: GCS is more likely to present in a young to middle-aged, otherwise healthy, male using drugs who is either found down or experienced an iatrogenic injury. Recognizing that GCS is different from that of the leg, in terms of etiology, may help avoid delays in diagnosis and treatment.
Asunto(s)
Síndromes Compartimentales , Fracturas Óseas , Persona de Mediana Edad , Humanos , Masculino , Adulto , Femenino , Estudios Retrospectivos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Nalgas , Fasciotomía/efectos adversos , Fracturas Óseas/complicacionesRESUMEN
Congenital brachial artery occlusion is rare. We report four patients who presented at birth with absent wrist pulses. We propose management recommendations that include anti-coagulation, duplex ultrasound assessment and fasciotomy surgery as early as is safe and possible.
Asunto(s)
Síndromes Compartimentales , Antebrazo , Recién Nacido , Humanos , Antebrazo/cirugía , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/cirugía , Extremidad Superior , Síndromes Compartimentales/diagnóstico por imagen , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Muñeca , Fasciotomía/efectos adversosRESUMEN
BACKGROUND: Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. HYPOTHESIS: Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values <0.05 were considered significant. RESULTS: A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest (P = 0.05) and with daily activity (P = 0.04), reduced postoperative improvement in Tegner scores (P = 0.04), and lower odds of return to sport (P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency (P < 0.01), pain severity at rest (P < 0.01) and with daily activity (P = 0.04), and return to sport (P = 0.04). CONCLUSION: ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. CLINICAL RELEVANCE: Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.
Asunto(s)
Síndromes Compartimentales , Pierna , Humanos , Masculino , Femenino , Estudios Retrospectivos , Pierna/cirugía , Fasciotomía/efectos adversos , Parestesia/cirugía , Parestesia/complicaciones , Enfermedad Crónica , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Dolor/etiología , Dolor/cirugíaRESUMEN
BACKGROUND: While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. METHODS: A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. RESULTS: The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. CONCLUSIONS: Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes.
Asunto(s)
Síndromes Compartimentales , Fracturas Óseas , Traumatismos de la Pierna , Humanos , Masculino , Adulto , Femenino , Fasciotomía/efectos adversos , Estudios Retrospectivos , Pierna , Pacientes Internos , Estudios Prospectivos , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/cirugía , Fracturas Óseas/complicaciones , Síndromes Compartimentales/cirugíaRESUMEN
Traumatic rhabdomyolysis is a systemic manifestation of muscle injury and can occur from various traumatic etiologies, including crush syndrome (CrshS) and compartment syndrome (CS). Although historically described in natural disaster survivors trapped under collapsed structures, the frequency of CrshS has increased in the setting of 'found down' patients from opioid overdoses. Signs and symptoms of the injured limb in CrshS may range from pressure-induced skin changes to neurologic deficits and paralysis. Although its pathophysiology differs from CS, severe injuries may lead to an associated CS. Identifying CS in a patient with CrshS can be difficult but is important to distinguish because it affects treatment. The degree of muscle damage, viability of the remaining muscular compartment, and presence of elevated compartment pressures dictate the need for surgical intervention in the form of fasciotomy. Surgical outcomes from CrshS and delayed CS result in similar high morbidity and surgical complications. This review defines and classifies the types of traumatic rhabdomyolysis and summarizes the outcomes to facilitate timely diagnosis and appropriate management for this population to reduce morbidity associated with these conditions.
Asunto(s)
Síndromes Compartimentales , Síndrome de Aplastamiento , Rabdomiólisis , Humanos , Síndrome de Aplastamiento/complicaciones , Rabdomiólisis/complicaciones , Rabdomiólisis/terapia , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Extremidades , Fasciotomía/efectos adversosRESUMEN
BACKGROUND: Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS: All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP ≥ 15 mm Hg at rest, and/or ≥30 mm Hg after 1 minute, and/or ≥20 mm Hg 5 minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS: A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n = 10; lat/ant CECS n = 54, lat/ant/dp CECS n = 19, lat/dp CECS n = 5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n = 2; lat/ant CECS n = 22, lat/ant/dp CECS n = 3, lat/dp CECS n = 1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n = 3; temporary complex regional pain syndrome with spontaneous recovery, n = 1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION: One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Síndromes Compartimentales , Pierna , Humanos , Pierna/cirugía , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/cirugía , Síndrome Compartimental Crónico de Esfuerzo/cirugía , Síndrome Compartimental Crónico de Esfuerzo/complicaciones , Fasciotomía/efectos adversos , Enfermedad Crónica , Dolor/etiología , Resultado del TratamientoRESUMEN
Our primary objective was to identify if fasciotomy was associated with increased mortality in patients who developed acute compartment syndrome (ACS) on extracorporeal cardiopulmonary resuscitation (ECPR). Additionally, we sought to identify any additional risk factors for mortality in these patients and report the amputation-free survival following fasciotomy. We retrospectively reviewed adult ECPR patients from the Extracorporeal Life Support Organization registry who were diagnosed with ACS between 2013 and 2021. Of 764 ECPR patients with limb complications, 127 patients (17%) with ACS were identified, of which 78 (63%) had fasciotomies, and 14 (11%) had amputations. Fasciotomy was associated with a 23% rate of amputation-free survival. There were no significant differences in demographics or baseline laboratory values between those with and without fasciotomy. Overall, 88 of 127 (69%) patients with ACS died. With or without fasciotomy, the mortality of ACS patients was similar, 68% vs. 71%. Multivariable logistic regression demonstrated that body mass index (BMI; adjusted odds ratio [aOR] = 1.22, 95% confidence interval [CI] = 1.01-1.48) and 24 hour mean blood pressure (BP; aOR = 0.93, 95% CI = 0.88-0.99) were independently associated with mortality. Fasciotomy was not an independent risk factor for mortality (aOR = 0.24, 95% CI = 0.03-1.88). The results of this study may help guide surgical decision-making for patients who develop ACS after ECPR. However, the retrospective nature of this study does not preclude selection bias in patients who have received fasciotomy. Thus, prospective studies are necessary to confirm these findings.
Asunto(s)
Reanimación Cardiopulmonar , Síndromes Compartimentales , Adulto , Humanos , Estudios Retrospectivos , Estudios Prospectivos , Reanimación Cardiopulmonar/efectos adversos , Reanimación Cardiopulmonar/métodos , Fasciotomía/efectos adversos , Fasciotomía/métodos , Sistema de Registros , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND Patients with post-fasciotomy CECS recurrence can experience significant mobility issues at baseline that limit independent living. For these patients, a repeat fasciotomy is not ideal because they are older and post-surgical scar tissue will make the fasciotomy technically challenging. Therefore, post-fasciotomy patients with CECS recurrence require new, non-surgical treatment options. Recent studies show botulinum toxin injections can be effective for the initial management of chronic exertional compartment syndrome (CECS) prior to surgery, especially in young patients primarily experiencing pain on exertion with minimal lower-extremity symptoms at rest. However, the ability to treat CECS recurrence status after fasciotomy with botulinum toxin injections of the legs has not been studied. CASE REPORT We present the first case where botulinum toxin was applied to this patient population. Our patient was a 60-year-old man with a 34-year history of CECS who, 8 years after his third bilateral fasciotomy, progressively developed rest pain in his calves bilaterally, paresthesias, and difficulties when walking or descending stairs, with multiple near-falls due to his toes catching on stair steps. OnabotulinumtoxinA (BTX-A) injections into the posterior and lateral compartments resolved baseline symptoms: within 2 weeks, he was able to walk, negotiate stairs symptom-free, and enjoy an overseas vacation without complications. CONCLUSIONS Symptoms related to recurrent CECS status after multiple fasciotomies can successfully be treated with BTX-A injections. Our patient's baseline mobility issues resolved within 2 weeks after the injection and remained that way for over 31 months. However, his exertional symptoms and rest pain recurred at 9 months, suggesting that BTX-A injections are not completely curative.
Asunto(s)
Síndrome Compartimental Crónico de Esfuerzo , Síndromes Compartimentales , Masculino , Humanos , Persona de Mediana Edad , Síndrome Compartimental Crónico de Esfuerzo/complicaciones , Fasciotomía/efectos adversos , Síndromes Compartimentales/tratamiento farmacológico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Extremidad Inferior , Pierna , Dolor/etiología , Enfermedad CrónicaRESUMEN
In sports, acute compartment syndrome (ACS) develops following lower limb fracture, with subsequent high intracompartmental pressures and pain out of proportion to the physical examination. A prompt diagnosis is the key to a successful outcome in patients with ACS. The goal of treatment of ACS, namely decompressive fasciotomy, is to reduce intracompartmental pressure and facilitate reperfusion of ischemic tissue before onset of necrosis. A delay in diagnosis and treatment may result in devastating complications, including permanent sensory and motor deficits, contractures, infection, systemic organ failure, limb amputation, and death.
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Síndromes Compartimentales , Fracturas Óseas , Humanos , Fasciotomía/efectos adversos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fracturas Óseas/complicaciones , Dolor , AtletasRESUMEN
BACKGROUND: Popliteal artery injuries are uncommon and often result in limb loss or long-term limb dysfunction. The aims of this study were (1) to evaluate the association between predictors and outcomes and (2) to validate the rational of systematic early fasciotomy. METHODS: This retrospective cohort study included 122 patients (80% men, n = 100) who underwent surgery for popliteal artery injuries from October 2018 to March 2021 in southern Vietnam. Primary outcomes included primary and secondary amputation. The associations between predictors and primary amputation were analyzed using logistic regression models. RESULTS: Among the 122 patients, 11 (9%) underwent primary amputation, while 2 (1.6%) had secondary amputation. Longer time to surgery was associated with increased odds of amputation (odds ratio = 1.65; 95% confidence interval, 1.2 to 2.2 for every 6 hr). Severe limb ischemia was also associated with a 50-fold increase in the risk of primary amputation (adjusted odds ratio = 49.9; 95% confidence interval, 6 to 418, P = 0.001). Furthermore, 11 patients (9%) without signs of severe limb ischemia and acute compartment syndrome on admission were found to have myonecrosis of at least one muscle compartment during fasciotomy. CONCLUSIONS: The data suggest that among patients with popliteal artery injuries, prolonged time before surgery and severe limb ischemia are associated with increased risk of primary amputation, whereas early fasciotomy may lead to improved outcomes.
Asunto(s)
Arteria Poplítea , Lesiones del Sistema Vascular , Masculino , Humanos , Femenino , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Arteria Poplítea/lesiones , Fasciotomía/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Isquemia/diagnóstico por imagen , Isquemia/cirugíaRESUMEN
OBJECTIVES: Fasciotomy to treat or prevent compartment syndromes in patients with truncal or peripheral arterial injuries is a valuable adjunct. The objective of this study was to document the current incidence, indications, and outcomes of below knee fasciotomy in patients with femoropopliteal arterial injuries. METHODS: The PROspective Observational Vascular Injury Treatment registry of the American Association for the Surgery of Trauma was utilized to identify patients undergoing two-incision four-compartment fasciotomy of the leg after repair of a femoropopliteal arterial injury. Outcomes after therapeutic versus prophylactic (surgeon label) fasciotomy were compared as was the technique of closure, that is, primary skin closure or application of a split-thickness skin graft (STSG). RESULTS: From 2013 to 2018, fasciotomy was performed in 158 patients overall, including 95.6% (151/158) at the initial operation. In the group of 139 patients who survived to discharge, fasciotomies were labeled as therapeutic in 58.3% (81/139) and prophylactic in 41.7% (58/139). There were no significant differences between the therapeutic and prophylactic groups in amputation rates (14.8% vs. 8.6%, P = .919). Primary skin closure was achieved at a median of 5.0 days vs. 11.0 days for STSG (P = .001). CONCLUSIONS: Over 55% of patients undergoing repair of an injury to a femoral or popliteal artery have a fasciotomy performed at the same operation. A "therapeutic" indication for fasciotomy continues to be more common than "prophylactic," while outcomes are identical in both groups.
Asunto(s)
Síndromes Compartimentales , Lesiones del Sistema Vascular , Humanos , Fasciotomía/efectos adversos , Extremidad Inferior , Síndromes Compartimentales/etiología , Síndromes Compartimentales/prevención & control , Síndromes Compartimentales/cirugía , Lesiones del Sistema Vascular/cirugía , Arteria Femoral/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. METHODS: A retrospective cohort study including 76 patients undergoing PF (n = 40) or TF (n = 36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi-squared-and log-rank test, respectively. RESULTS: E-GFR improved over the in-hospital period with 8.2 ml/min/1.73 m2 (95% confidence interval [CI] 2.4-14.1, P = 0.007) in the PF group and 4.4 ml/min/1.73 m2 (95% CI 1.2-7.7, P = 0.010) in the TF group, with no significant difference between the 2 groups (0.3 ml/min/1.73 m2, 95% CI -6.7 to 7.4, P = 0.93). The wound infection rate was higher after TF (PF = 60.6 % and TF = 82.4 %, P = 0.048), whereas rate of other wound complications (PF = 61.3 % and TF = 35.3%, P = 0.036) was higher after PF. CONCLUSIONS: Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.