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J Surg Res. 2015 Jan;193(1):449-57. doi: 10.1016/j.jss.2014.07.016. Epub 2014 Jul 16.

Prophylactic fasciotomy in a porcine model of extremity trauma.

Author information

1
59th Medical Wing, Joint Base San Antonio, San Antonio, Texas; The US Army Institute of Surgical Research, Fort Sam Houston, Texas.
2
The US Army Institute of Surgical Research, Fort Sam Houston, Texas.
3
The US Army Institute of Surgical Research, Fort Sam Houston, Texas; Academic Department Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
4
59th Medical Wing, Joint Base San Antonio, San Antonio, Texas.
5
59th Medical Wing, Joint Base San Antonio, San Antonio, Texas; US Combat Casualty Care Research Program, Fort Detrick, Maryland; Harris B. Shumacker, Jr. Professor of Surgery, The Uniformed Services University, Bethesda, Maryland. Electronic address: todd.e.rasmussen.mil@mail.mil.

Abstract

BACKGROUND:

Extremity injury, with concomitant hemorrhagic shock, can result in ischemia-reperfusion injury and the formation of compartment syndrome requiring fasciotomy. As the benefit of prophylactic fasciotomy is unclear, the objective of this study is to determine the functional recovery of an ischemic limb with hemorrhagic shock after prophylactic fasciotomy.

MATERIAL AND METHODS:

Yorkshire swine underwent 35% blood volume hemorrhage, followed by 1, 3, and 6 h of ischemia (n = 17; 1HR, 3HR, and 6HR) via iliac artery occlusion followed by repair and reperfusion. A second cohort (n = 18) underwent fasciotomy of the anterior compartment of the hind limb following vascular repair (1HR-F, 3HR-F, and 6HR-F). Compartment pressures, measures of electromyographic (EMG) recovery, and a validated gait score (modified Tarlov) were performed throughout a 14-d survival period.

RESULTS:

Increasing ischemic intervals resulted in incremental increases in compartment pressure (P < 0.05), although the mean did not exceed 30 mm Hg. EMG studies did not show a significant improvement comparing the 3HR with 6HR groups. There was a significant improvement in the EMG studies within the 3HR-F, when compared with 6HR-F. There was a trend toward sensory improvement between the 3HR-F and 3HR groups. However, this did not translate to a difference in functional outcome as measured by the Tarlov gait score.

CONCLUSIONS:

Within this swine model of hemorrhagic shock and hind limb ischemia, the use of prophylactic fasciotomies did not improve functional outcome.

KEYWORDS:

Extremity; Fasciotomy; Functional; Ischemia–reperfusion; Neuromuscular; Recovery; Vascular injury

PMID:
25124897
DOI:
10.1016/j.jss.2014.07.016
[Indexed for MEDLINE]

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