Diagnosis of Compartment Syndrome Based on Tissue Oxygenation
Abstract
The diagnosis of acute compartment syndrome (CS) remains problematic due to difficulty in diagnosis. Continuous measurement of intramuscular tissue oxygenation (PmO2) of the leg has been shown to be feasible in humans and highly responsive to induced compartment syndrome and fasciotomy in a dog model. Using the same model, we investigated the relationship between PmO2 after fasciotomy and biochemical measurements of tissue viability. Under general anesthesia, CS was induced in the anterolateral compartment of one hind limb via Hespan infusion with predetermined goal pressures 30 mmHg, 10 mmHg, and 0 mmHg above diastolic blood pressure. Polarographic oxygen probes were placed percutaneously into the anterolateral compartment. PmO2 was recorded every 30 seconds. After approximately 7 hours of compartment syndrome, fasciotomy was performed. Animals were euthanized 2 weeks postoperatively at which point muscle biopsies were performed. Tissue viability was assessed by histologic analysis (H&E, Masson's Trichrome, and Cytochrome C Oxidase stains) and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. In the deltaP < -30 mmHg group, the averaged mean PmO2 before the infusion-induced CS was 35.63 mmHg (range 15.22-53.65 mmHg). During induced CS, PmO2 decreased to an average of 2.54mmHg (range 0.19-4.92 mmHg, p<0.05 Wilcoxon rank sum test). Following fasciotomy, PmO2 recovered in half of the animals to an averaged mean of 40.11mmHg (range 22.33- 57.89 mmHg), whereas in the other half, PmO2 did not recover and remained at an averaged mean of 4.07 mmHg (range 0.85-7.29 mmHg). In the deltaP = -10 mmHg group, the averaged mean PmO2 before CS was 36.44 mmHg (range 21.79-48.5 mmHg). During induced CS, PmO2 decreased to an average of 3.45 mmHg (range 0.26-5.04 mmHg, p<0.05). Following fasciotomy, PmO2 recovered to an averaged mean of 47.24 mm Hg(range 23.15-87.55 mmHg). In the deltaP = 0 mmHg group, mean PmO2 before CS was 22.59 mmHg.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2012
- Accession Number
- ADA573821
Entities
People
- Hubert Kim
Organizations
- Northern California Institute for Research and Education