Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature
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(2020) 15:60
REVIEW
Open Access
Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature Federico Coccolini1* , Mario Improta2, Edoardo Picetti3, Luigi Branca Vergano4, Fausto Catena5, Nicola de ’Angelis6, Andrea Bertolucci1, Andrew W. Kirkpatrick7, Massimo Sartelli8, Paola Fugazzola9, Dario Tartaglia1 and Massimo Chiarugi1
Abstract Compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3–12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event. Keywords: Hypertension, Decompressive craniectomy, Compartment syndrome, Extremities, Ocular, Plycompartment
Introduction The ability to tolerate rise in pressure of a closed area of the body, depends on three main factors: the compliance—the extent to which that region can expand to adjust the increasing pressure—the degree of vascular and nervous damage that occurs in the area, and the physiological effects that the increasing pressure generate on the body homeostasis. It is explicit that some compartments can only briefly tolerate an acute rise in pressure due to its detrimental effect like hemodynamic instability seen in tension pneumothorax or cardiac tamponade * Correspondence: [email protected] 1 General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy Full list of author information is available at the end of the article
even if those pathological entities seldom are included among “compartmental syndromes”. In fact, compartment syndrome properly defined is the pressure increase inside a defined body compartment. When tissue interstitial pressure becomes higher than the capillary one, cells get insufficient blood supply. To revert those scenarios, generally urgent intervention may be required. Uncertainty exists in regard to the timing of intervention of more complex, urgent compartmental syndromes. The resistance of the different tissues to hypoxia and hypoperfusion is unknown. Different tissues, in fact, have differe
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