Abstract: | Summary
The compartment syndrome (cs) is characterized by an increased tissue pressure in a limited space. Pathophysiologically, it
is a multifactorial disease that is potentially induced by an initial trauma and develops according to the existence of cofactors.
Cofactors are, for instance, the circulation of the patient and the initial treatment of the impending cs. In particular,
the microcirculation is altered with endothelial destruction, development of a capillary leak, protein loss from intravasal
space and the development of an interstitial and intracellular third space. An impaired drainage of the lymphatic and venous
system causes a venous infarction. An arterial infarction results if the tissue pressure exceeds the arteriolar pressure.
An accompanying ischemia reperfusion mechanism increases the trauma load. In disadvantageous cases, the patients are in danger
of developing a multi-organ deficiency syndrome (MODS) by an uncontrolled inflammatory reaction, by intravasal volume loss
and by a myonephropathic systemic reaction. Clinically, the patients suffer a disproportionate amount of pain, followed by
neurological signs. Especially in noncompliant patients, tissue pressure measurement is useful. Resuscitation of the circulation
as well as splitting of casts is important. In case of a manifest cs, dermatofasciotomy has to be performed as an emergency
operation. Even if cs is diagnosed early and fasciotomy is carried out early, the development of sequellae cannot be avoided
in every single case.
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