Kompartman Sendromu Nedeniyle Erken Fasiotomi Yapılan Hastada Sinir Fonksiyonlarının Kademeli İyileşmesi

Öz

Literatürde bildirilen ateşli silah yaralanmalarının insidansı motorlu araç kazaları, spor yaralanmaları veya endüstriyel kazalar için bildirilenlerden daha yüksektir. Alt ekstremitelerin vasküler travması, hızlı tanı ve tedavi gerektiren akut arteryel yetersizliğe neden olabilir. Vasküler yaralanmayı takiben kompartman sendromu da prosedürü daha komplike hale getirebilir ve ekstremite kaybı riskini arttırır. Bu makalede, kompartman sendromu ile komplike olan travmatik bir sol ön tibial arterin başarılı cerrahi tedavisini ve sonuçta nöral sekelin çözümünü sunuyoruz. Akut arteriyel yaralanmalardaki iskemi süresini en aza indirgemek için çaba göstermeliyiz. Kompartman sendromu, iskemi süresi düşükken bile cerrahi onarımı takip edebilir ve tüm klinik seyir boyunca nabızlar palpabl olabilir. Seçilmiş vakalarda kompartman basınç ölçümü yerine klinik tanı ve cerrahi eksplorasyon tercih edilebilir.

Anahtar Kelimeler

• Kompartman sendromu,düşük ayak,ateşli silah yaralanması,akut arter hasarı

Early Fasciotomy due to Compartment Syndrome with Gradual Recovery of Nerve Function

Öz

Abstract

The incidence of gunshot wounds reported in the literatureare is higher than those reported for motor vehicle accidents, sports injuries, or industrial accidents. Vascular trauma of the lower extremities may lead to acute arterial insufficency which requires rapid diagnosis and treatment. Compartment syndrome following vascular injury may also further complicate the process, increasing the risk of limb loss. 
In this article, we present the successful surgical treatment of a traumatic left anterior tibial artery complicated by compartment syndrome and eventual resolution of neural sequela. All effort should be made to minimize ischemia time in acute arterial injuries. Compartment syndrome may follow surgical repair even when ischemia time is low and the pulses were palpable during the entire cilinical course. Clinical diagnosis and surgical exploration may be preferable instead of compartmental pressure recordings and observation in selected cases.

Anahtar Kelimeler

• Compartment syndrome,drop foot,gunshot wound

Kaynakça

1. 1. Rowe VL, Yellin AE, Weaver FA. Vascular Injuries of the Extremities. In: Rutherford RB, editor. Vascular Surgery. 7th ed. Philadelphia, Pennsylvania: Elsevier Saunders; 2010.
2. 2. Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma 1996;40(3):342-4.
3. 3. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br 2003;85(5):625-32.
4. 4. F. Paldberg Jr. and W. N. Dur´an, “Acute limb ischemia,” in Comprehensive Vascular and Endovascular Surgery, J.W.Hallett, J. L.Mills, J. J. Earnshaw, and T.W. Reekers, Eds. , Mosby, Philadelphia, Pa, USA, 2nd edition, 2009. p. 282.
5. 5. Hargens AR, Akeson WH, Mubarak SJ, et al. Fluid balance within the canine anterolateral compartment and its relationship to compartment syndromes. J Bone Joint Surg.1978;60(4):499-505.
6. 6. Mubarak SJ, Owen CA, Hargens AR, et al. Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am 1978;60(8):1091-5.
7. 7. Koman LA, Hardaker WT, Jr. Goldner JL. Wick catheter in evaluating and treating compartment syndromes. South Med J 1981;74(3):303-9.
8. 8. Gelberman RH, Szabo RM, Williamson RV, et al. Tissue pressure threshold for peripheral nerve viability. Clin Orthop Relat Res 1983;178:285-91.

9. 9. Frykberg ER. Popliteal vascular injuries. Surg Clin North Am 2002;82(1):67-89.
10. 10. Sheridan GW, Matsen FA, 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am 1976;58(1):112-5.