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• Strykcr®dedicateddevice(Su)'kerPressuremonitorilndQuickpressuremonitorsystem). 

• Pressuretransducer from CVPmonitorandhypodermicneedle(19Gor21G). 

• Manometer. 

• Measuringcompartmentpressure: 

• Calibrateinstrument. 

• IllSC!n nealleorcatheterintocompanmentandtake

pressurereading.

• Takemeasuremenlsfromdifferentsitesin thecom· 

panment(compartmentSarenotnuid,sopressure

varieswithinrompartmem).

• Measurementsdependontechniqueandmayvary 

betweenoperators.

• Lookat the trend if a single measurementsis

equi\'Ocal.

• CancomparewithCOntralateralunaffectedlimb if  

unsure.

• Whentointervene: 

• 30mmHgfor8hoursorunknownperiod. 

• 2QmmHgbelowdiastolicpressure. 

• Oinicalsuspicionpluspressureof30mmHg. 

• Bloodtests. Checkcreatinekinase(C.... 1andureaand

electrolrtC5..AveryhighCKmayindicatemusclenecrosis..Thismarleadtoacuterenalf3ilure.somonitorU&

ESandconsiderearlyrenaldial)'sisifindicated(speak

10ITUand/orrenalph)'sicians).

Operativetreatment

fu(iotomyoftheupperandlowerlimbs:

generalprinciples

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• Gcneralorregionalanaesthesia

• Usetourniquetforsafeinitial exposure. 

• Mustbecompleteandfulliellgth. 

• Incise the skill tdermOIOIIl)') and deepfascia (fasciotomyl. 

• Dcsib'tlincisions toavoidexposednervesortendons. 

• Try10minimizeCUHllleOliSnervedamageandpreserve

longitudinalveins.

• Closed,subcutaneousfasciotomyis NOTindicatedin 

trauma.

• Examinethe epimrsiumofindividu31 musclebellies 

systematicallyandincisewhentight (epimysiotomy).

• Exciseobviouslydead musclewiththe tourniquet

inflated,orpriortorevascularizationtoreducetherisk

ofacuterenalfailurefrommyoglobin3emiaIfindoubt.

donotcxciseit, andlook ag3inafterthe tourniquet

is dellalCd(dead muscledoesnotbleed.is softand

Do,so·radialfasciotomy

Dorso-ulna,lasciotomy I

',. ;;;;;~~~~~

I

Palma,filsci(Momy

• DorNI~l"" 'eI(4) ......_lnlerouel(3) 

• Addldlf'poIIds • Thenarmusdes H)potIl8il8fIT'USdllS 

fig. 11.1 Anatomyofttle ten rompartments01the handin

uos:s·l.eCl:ion.

mushy.doesnOltwitch.andiseitherdarkor\'erypale

(notpink}).

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• ReleasethelOumlquet toassessmusde\;ability.

• Performasecondlookat24\048hours..

fasciotomyoftheupperlimb

• Removeanyringsfrom thedigits. 

• Positionthcpatientsupineontheoperatingtablewith 

thearmonahandtable.

• ApplyahightourniquctlO thearm. 

• Cleanthcarmto theaxillawilhsurgicaldisinfectant.

• DrJpethearllljust belowthetourniquet. 

Thehand

Thisis confusing unlessyouunderstandthe anatomy

ofthe 10 compartmentsofthe h'll\din cross-section

(Fig. 17.ll.Thesearc:

• Dorsalinterossei (4). 

• Palmarinterossei(3). 

• Adductor(OftCII neglected).

• Thenar. 

• Hypothenar. 

Dorsalincisions (fig. 17.2)