Papalambros E L, Panayiotopoulos Y P, Bastounis E, Zavos G, Balas P
1st Surgical Clinic, Medical School University of Athens, Laikor General Hospital, Greece.
Int Angiol. 1989 Jul-Sep;8(3):120-4.
During the 3-year period, 1983-86, 194 procedures for acute arterial occlusion were performed in our Clinic. In 43 cases following revascularization procedures, decompression fasciotomy of the leg for a developed or impending compartment syndrome was performed. Of these, three fasciotomies were done as a prophylactic procedure, before the development of the syndrome. Adequate and early fasciotomy should be considered by the vascular surgeon in every case of embolectomy when the ischemic time is greater than 6 hours, when the patient is young without sufficient collateral circulation, the history of acute arterial occlusion is precipitous, the patient is hypotensive and the back-flow is inadequate intra-operatively, despite the passage of the Fogarty's catheter down to the malleolus. Skin closure after fasciotomy has to be done early, mainly with approximation of the skin edges, or to cover early the exposed viable muscles with a free split-thickness autogenous skin graft. This was done in our series between the 8th and 14th postoperative days. In the case of muscle necrosis of the anterior compartment, skin coverage of the cavity has to be done later, after 2-3 weeks, as in some of our patients.
在1983年至1986年的3年期间，我们诊所共进行了194例急性动脉闭塞手术。在43例血管重建手术后，因出现或即将出现骨筋膜室综合征而对腿部进行了减压筋膜切开术。其中，有3例筋膜切开术是在综合征出现之前作为预防性手术进行的。当缺血时间超过6小时、患者年轻且侧支循环不足、急性动脉闭塞病史急促、患者血压低且术中回血不足（尽管Fogarty导管已插入至踝部）时，血管外科医生在每例栓子切除术病例中都应考虑进行充分且早期的筋膜切开术。筋膜切开术后的皮肤闭合必须尽早进行，主要是将皮肤边缘拉拢，或者尽早用自体中厚皮片覆盖暴露的存活肌肉。在我们的系列病例中，这是在术后第8天至第14天之间完成的。在前侧骨筋膜室肌肉坏死的情况下，如我们的一些患者那样，必须在2至3周后对腔隙进行皮肤覆盖。
