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Hand and Upper Limb Emergencies
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Compartment syndrome is a limb-threatening condition in which increased pressure within a closed (fascial) compartment compromises blood flow to muscles and nerves. If untreated it leads rapidly to tissue ischaemia and necrosis, which can ultimately result in loss of function, loss of limb, rhabdomyolysis and renal compromise. In the upper limb, compartment syndrome most commonly affects the deep compartment of the forearm but it can also affect other compartments of the forearm, hand and (less commonly) the upper arm. Acute compartment syndrome is a surgical emergency for which the only definitive management is decompression with fasciotomies. Time to theatres is crucial as irreversible tissue injury starts at approximately 3 hours of warm ischemia with 6 hours as the upper limit of muscle viability.
Bone Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
Long bones are contained within fascial compartments. The medullary canal forms an inner compartment with variations of intravascular hydrostatic pressure from 16 mm in the diaphysis to 27 mmHg in the metaphysis of the tibia, (±7 mmHg for the heart pulse component).30 Outside the bone compartment, the pressure drops to 19 mmHg in the nutrient vein, from an inflow nutrient artery value of 123 ± 15 mmHg.104 High medullary canal pressures could result from contraction of muscles supplying vasculature to the periosteum or from increased compartment pressures outside the bone.
Extremity Trauma
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
In the lower arm, the dorsal compartment of the extensors can be opened by direct approach. Ventral fasciotomy of the flexors should be completed with release of the carpal tunnel distally and division of the lacertus fibrosis in the elbow region proximally (Figure 11.3). Incision of the dorsal and volar compartment of the forearmA long incision, anterolaterally, 2 cm anterior to the shaft of the fibula. The anterior and lateral fascial compartments are opened separately.A long posteromedial incision is made 2 cm posterior to the medial border of the tibia. The subcutaneous tissue is pushed away by blunt dissection, and the superficial and deep posterior compartments are opened separately.
Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones?
Published in Expert Review of Cardiovascular Therapy, 2019
Elijah Sanches, Marieke Timmermans, Besir Topal, Alper Celik, Magnus Sundbom, Rui Ribeiro, Chetan Parmar, Surendra Ugale, Monika Proczko, Pieter S. Stepaniak, Juan Pujol Rafols, Kamal Mahawar, Marc P. Buise, Aleksandr Neimark, Rich Severin, Sjaak Pouwels
Epicardial fat and ventricular fatty infiltration are present in approximately 3% of the obese individuals. This can be associated with ventricular dysfunction [28]. Ventricular adipocytes can induce steatosis that can act as direct cardiotoxins [28]. Anatomically, epicardial fat can induce cardiac dysfunction, because the myocardium has no fascial compartments to separate muscular and fatty layers, which share the same local blood supply [28–30]. Regarding biochemical properties, epicardial fat reflects a tendency toward increased lipolysis and low mitochondrial oxidative capacity reinforced by the pro-atherogenic modulation of adipokines (decreased adiponectin and increased resistin) and inflammatory factors, which can contribute to adverse ventricular remodeling [29–31]. There is a complex interplay between obesity, epicardial adipose tissue and the occurrence of cardiac rhythm disorders, of which atrial fibrillation is the most studied [32]. The Framingham Heart Study showed that the presence of pericardial fat volume predicts the occurrence of AF, independent of other anthropometric variables like BMI [33]. However, according to Rabkin et al. [34], there is a significant correlation between epicardial adipose tissue (EAT) and BMI, waist circumference, or visceral adipose tissue. Also, Al Chekakie et al. [35] has demonstrated that pericardial fat is highly associated with AF, independent of traditional risk factors.
Chronic exertional compartment syndrome of the forearm
Published in The Physician and Sportsmedicine, 2019
Kunal Sindhu, Brian Cohen, Joseph A. Gil, Travis Blood, Brett D. Owens
Chronic exertional compartment syndrome (CECS) is an overuse injury that occurs when a stiff fascial muscle compartment cannot accommodate the increase in volume that occurs when muscles contract and swell during exertion [1,2]. The increase in pressure within the fascial compartment compresses both vessels and nerves, leading to ischemia and pain [3]. CECS was first described in 1912, but it was not linked to increased intracompartmental pressure until 1956 [4]. Unlike acute compartment syndrome, the ischemia associated with CECS is reversible, with symptoms typically receding after the cessation of exercise and patients are typically asymptomatic at rest [5].