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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Severe crush injuries or comminuted fractures of the limbs may be complicated by the development of Compartment Syndrome (CS), where hematoma or edema increase the tissue pressure inside a closed fascial space, cutting off the arterial blood supply to the muscles within that space. Even milder injuries or a cast that is applied too tightly may cause CS. Arterial pulses distal to the injury usually remain full. Severe pain occurs and muscle necrosis may result unless emergency fasciotomy is performed to relieve the compartment pressure. Forearm fractures involving both radius and ulna, as well as tibial fractures of the leg, are most prone to CS complications.25 A study using thermography to aid in the detection of CS showed a highly significant “thigh-foot index” (TFI), or difference between thigh and ankle temperatures, of over 8°C (150F) in the involved leg as compared to about 2°C (3.6°F) in the uninvolved normal leg (Figure 11.8).26
Contrast media extravasation
Published in William H. Bush, Karl N. Krecke, Bernard F. King, Michael A. Bettmann, Radiology Life Support (Rad-LS), 2017
To date, there have been only three reports of injuries produced by extravasated nonionic contrast media. One of these involved the development of skin ulceration after extravasation of 150 mL from an upper extremity injection site.16 The extravasation occurred while an automatic blood-pressure cuff was left inflated during the injection. In the second case, a ‘compartment syndrome’ resulted from injection of over 100 mL of a nonionic agent into a patient’s forearm.17 The third case involved extravasation of 60 mL of ioversol 320 mg/mL into the dorsum of the hand during a CT examination, which produced swelling and blistering. A ‘compartment syndrome’ developed, necessitating an emergency fasciotomy.18
Clinical Effects of Pollution
Published in William J. Rea, Kalpana D. Patel, Reversibility of Chronic Disease and Hypersensitivity, Volume 5, 2017
William J. Rea, Kalpana D. Patel
Some surgeons advocate the use of fasciotomy in patients in whom compartment syndromes related to tissue edema can compromise flow into a limb.508,515 However, fasciotomy disrupts the skin barrier and usually results in the interruption or postponement of anticoagulant therapy and so is not without risk. Early amputation should be avoided, whenever possible, since it can be difficult to distinguish viable tissue from nonviable tissue. Indeed, patience to the point of autoamputation in some cases can minimize ultimate tissue losses. A multidisciplinary team that involves plastic surgery or wound care, medicine or infectious diseases, and podiatry, with management in a burn unit, can be helpful.
Comparison and convergence of compartment syndrome techniques: a narrative review
Published in Expert Review of Medical Devices, 2023
Naveen Sharma, Nitin Mohan Sharma, Apurva Sharma, Sarfaraj Mirza
As stated above, ACS is generally considered a medical emergency. The aim is to decrease the pressure inside the compartment, so that tissue damage can be minimized. Any external splint, cast, or dressing may also be removed to lower the ICP [54]. One sided release of the plaster cast can result in a reduction of pressure by 30%, whereas bivalving the cast may help in reducing another 35% pressure, and cutting the dressing may reduce the ICP by 10 to 20% [55]. However, the widely accepted treatment for CS is surgical, as clinical treatments are doubted and need much time and history. For ACS, fasciotomy (surgery) is the only treatment available. In fasciotomy, the muscle compartment is opened up to let the muscle tissue swell, lower the pressure, and allow blood flow to return. Fasciotomy is the procedure of exposing the skin and muscular fascia covering the affected compartment or compartments at abnormal regions. It allows more blood flow to reach the tissue by releasing compartment pressure from enclosed muscle. But before treatment, it should be 100% certain whether the pain is due to the presence of CS or not. That means, the symptoms and indications for performing a fasciotomy must be taken into account.