Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Orthop Surg. 2022 Jan;14(1):169-173. doi: 10.1111/os.13177. Epub 2021 Dec 6.
After extracorporeal membrane oxygenation (ECMO), acute compartment syndrome (ACS) can develop because of limb ischemia or reperfusion. The standard treatment for ACS is emergency fasciotomy. We introduced an interrupted incision technique instead of a long double-incision to reduce blood loss and subsequent hypovolemia in ECMO patients.
Two patients were treated venoarterial ECMO with heparinization by inserting cannulas into their right femoral vessels: Case #1 after emergency pulmonary thrombectomy for massive pulmonary thrombi and Case #2 after percutaneous coronary intervention for ST-elevation myocardial infarction with ventricular fibrillation. Some of the '5 P' signs of ACS were detected on their right legs. We treated them with the interrupted incision fasciotomy: four or five skin incisions of 2-3 cm each on lateral side; one 6-7 cm proximal skin incision with one or two separate short distal skin incisions of 1-1.5 cm each on the posteromedial side. The subcutaneous layer was also incised through these interrupted incisions; interrupted multiple "soft tissue tunnels" can be formed above muscle layer between the incisions. Once the fascia was exposed, the connected fasciotomy was performed with the knife blade facing subcutaneous layer, rather than muscle. The two patients' foot pulse, skin color, and muscle tone were immediately restored, and delayed primary wound closures were possible. Both patients were satisfied with their limb salvage and could walk with a little help using an orthosis or a cane.
We recommend the interrupted incision fasciotomy as an attractive and effective technique for ACS, particularly after ECMO.
体外膜肺氧合（ECMO）后，由于肢体缺血或再灌注，可能会发生急性间隔综合征（ACS）。ACS 的标准治疗方法是紧急筋膜切开术。我们引入了一种间断切口技术，而不是长双切口，以减少 ECMO 患者的出血和随后的低血容量。
两名患者通过将导管插入其右股血管，接受了静脉动脉 ECMO 治疗和肝素化：病例 1 是为了治疗大量肺血栓而进行的紧急肺动脉血栓切除术，病例 2 是为了治疗 ST 段抬高型心肌梗死伴心室颤动而行的经皮冠状动脉介入治疗。他们的右腿出现了 ACS 的一些“5P”征象。我们对他们进行了间断切口筋膜切开术：在外侧切开 4 或 5 个 2-3 厘米长的皮肤切口；在后方切开一个 6-7 厘米长的近端皮肤切口，在每个切口上切开 1-1.5 厘米长的两个单独的短皮切口。通过这些间断切口也切开了皮下层；可以在切口之间的肌肉层上方形成间断的多个“软组织隧道”。一旦暴露筋膜，就用刀片朝向皮下层而不是肌肉进行连接的筋膜切开术。两名患者的足部脉搏、肤色和肌肉张力立即恢复，可以进行延迟的一期伤口闭合。两名患者对肢体保存都很满意，并且可以在使用矫形器或拐杖的帮助下进行小范围行走。
我们推荐间断切口筋膜切开术作为 ACS 的一种有吸引力和有效的技术，特别是在 ECMO 之后。
