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Peripheral Compartment Syndrome

Peripheral compartment syndrome (PCS) is a major cause of morbidity in soldiers with traumatic extremity injuries. It occurs when the pressure within a muscle compartment exceeds that of the circulation. Acute crush, vascular and orthopedic injuries, which present commonly in military medicine, often lead to the development of PCS. Sequelae of an increase in intra-compartmental pressure include ischemia, necrosis and nerve damage. If untreated, PCS may lead to limb amputation, multiple organ failure and death.

  Treatment of animal model with ECM results in myogenesis
  fibrous tissue in fasciotomy treated groups after 3 months
 

Treatment of animal model with ECM results in myogenesis (top), whereas there is only fibrous tissue in fasciotomy treated groups (bottom) after 3 months.

PCS is characterized by symptoms including pain, pallor, absent pulses, parasthesia and loss of function. It is usually recognised by measurement of the intracompartmental pressure, which is considered diagnostic when it exceeds 30-40 mm Hg. Intracompartmental pressure greater than 12 mm Hg will cause cessation of blood flow in 50% of capillaries (1). Consequently, tissue ischaemia is a significant factor in the pathology of this syndrome. In addition, 6 to 8 hours of tissue ischaemia will result in irreversible damage to the muscle and peripheral nerves (2, 3), which is a serious complicating factor in the long term recovery of function.

The current best standard of care for PCS is an open fasciotomy, however this procedure is still associated with high levels of morbidity. In addition, a delay of 6-8 hours in treatment increases the incidence of permanent myonecrosis, infection amputation and mortality further (3). Such delays may be common in a military setting (4), making PCS a major concern in soldiers with traumatic extremity injuries. The potential complications and higher level of morbidity associated with the treatment of PCS necessitate the development of better therapeutic options.

A regenerative medicine approach to treatment of PCS may help to decrease the incidence of morbidity and improve the quality of life post injury. The overall goal of such an approach is the reconstitution of functional, vascularized and innervated musculotendinous tissue. Extracellular matrix (ECM) is generated by cells, and provides structural and functional support. Decellularization of cellular material in vitro produces ECM that may be used in vivo to facilitate tissue regeneration. A focus of this project is the development of new treatment modalities for PCS that make use of recent advances in the field of regenerative medicine and the use of biologic scaffolds.

References

  1. Vollmar, B., S. Westermann, and M. D. Menger. 1999. Microvascular response to compartment syndrome-like external pressure elevation: an in vivo fluorescence microscopic study in the hamster striated muscle. J Trauma 46:91-96. PMID: 9932689
  2. Goaley, T. J., Jr., A. D. Wyrzykowski, J. B. MacLeod, K. B. Wise, C. J. Dente, J. P. Salomone, J. M. Nicholas, G. A. Vercruysse, W. L. Ingram, G. S. Rozycki, and D. V. Feliciano. 2007. Can secondary extremity compartment syndrome be diagnosed earlier? Am J Surg 194:724-726; discussion 726-727. PMID: 18005761
  3. Pai, V. 2007. Acute compartment syndrome after rupture of the medial head of gastrocnemius in a child. J Foot Ankle Surg 46:288-290. PMID: 17586443
  4. Ritenour, A. E., W. C. Dorlac, R. Fang, T. Woods, D. H. Jenkins, S. F. Flaherty, C. E. Wade, and J. B. Holcomb. 2008. Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma 64:S153-161; discussion S161-152. PMID: 18376159

 

 

 

Updated 01-Dec-2010