Prophylactic fasciotomy in a porcine model of extremity trauma

Thomas J. Percival, Shimul Patel, Nickolay P. Markov, Jonathan J. Morrison, Jerry R. Spencer, James Ross, Todd E. Rasmussen

Research output: Contribution to journalArticle

Abstract

Background: Extremity injury, with concomitant hemorrhagic shock, can result in ischemia -reperfusion injury and the formation of compartment syndrome requiring fasciotomy. As the benefit of prophylactic fasciotomy is unclear, the objective of this study is to determine the functional recovery of an ischemic limb with hemorrhagic shock after prophylactic fasciotomy. Material and methods: Yorkshire swine underwent 35% blood volume hemorrhage, followed by 1, 3, and 6 h of ischemia (n = 17; 1HR, 3HR, and 6HR) via iliac artery occlusion followed by repair and reperfusion. A second cohort (n = 18) underwent fasciotomy of the anterior compartment of the hind limb following vascular repair (1HR-F, 3HR-F, and 6HR-F). Compartment pressures, measures of electromyographic (EMG) recovery, and a validated gait score (modified Tarlov) were performed throughout a 14-d survival period. Results: Increasing ischemic intervals resulted in incremental increases in compartment pressure (P <0.05), although the mean did not exceed 30 mm Hg. EMG studies did not show a significant improvement comparing the 3HR with 6HR groups. There was a significant improvement in the EMG studies within the 3HR-F, when compared with 6HR-F. There was a trend toward sensory improvement between the 3HR-F and 3HR groups. However, this did not translate to a difference in functional outcome as measured by the Tarlov gait score. Conclusions: Within this swine model of hemorrhagic shock and hind limb ischemia, the use of prophylactic fasciotomies did not improve functional outcome.

Original languageEnglish (US)
Pages (from-to)449-457
Number of pages9
JournalJournal of Surgical Research
Volume193
Issue number1
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Swine
Extremities
Hemorrhagic Shock
Wounds and Injuries
Gait
Ischemia
Pressure
Compartment Syndromes
Iliac Artery
Blood Volume
Reperfusion Injury
Reperfusion
Blood Vessels
Fasciotomy
Hemorrhage

Keywords

  • Extremity
  • Fasciotomy
  • Functional
  • Ischemia-reperfusion
  • Neuromuscular
  • Recovery
  • Vascular injury

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Percival, T. J., Patel, S., Markov, N. P., Morrison, J. J., Spencer, J. R., Ross, J., & Rasmussen, T. E. (2015). Prophylactic fasciotomy in a porcine model of extremity trauma. Journal of Surgical Research, 193(1), 449-457. https://doi.org/10.1016/j.jss.2014.07.016

Prophylactic fasciotomy in a porcine model of extremity trauma. / Percival, Thomas J.; Patel, Shimul; Markov, Nickolay P.; Morrison, Jonathan J.; Spencer, Jerry R.; Ross, James; Rasmussen, Todd E.

In: Journal of Surgical Research, Vol. 193, No. 1, 2015, p. 449-457.

Research output: Contribution to journalArticle

Percival, TJ, Patel, S, Markov, NP, Morrison, JJ, Spencer, JR, Ross, J & Rasmussen, TE 2015, 'Prophylactic fasciotomy in a porcine model of extremity trauma', Journal of Surgical Research, vol. 193, no. 1, pp. 449-457. https://doi.org/10.1016/j.jss.2014.07.016
Percival, Thomas J. ; Patel, Shimul ; Markov, Nickolay P. ; Morrison, Jonathan J. ; Spencer, Jerry R. ; Ross, James ; Rasmussen, Todd E. / Prophylactic fasciotomy in a porcine model of extremity trauma. In: Journal of Surgical Research. 2015 ; Vol. 193, No. 1. pp. 449-457.
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AU - Spencer, Jerry R.

AU - Ross, James

AU - Rasmussen, Todd E.

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N2 - Background: Extremity injury, with concomitant hemorrhagic shock, can result in ischemia -reperfusion injury and the formation of compartment syndrome requiring fasciotomy. As the benefit of prophylactic fasciotomy is unclear, the objective of this study is to determine the functional recovery of an ischemic limb with hemorrhagic shock after prophylactic fasciotomy. Material and methods: Yorkshire swine underwent 35% blood volume hemorrhage, followed by 1, 3, and 6 h of ischemia (n = 17; 1HR, 3HR, and 6HR) via iliac artery occlusion followed by repair and reperfusion. A second cohort (n = 18) underwent fasciotomy of the anterior compartment of the hind limb following vascular repair (1HR-F, 3HR-F, and 6HR-F). Compartment pressures, measures of electromyographic (EMG) recovery, and a validated gait score (modified Tarlov) were performed throughout a 14-d survival period. Results: Increasing ischemic intervals resulted in incremental increases in compartment pressure (P <0.05), although the mean did not exceed 30 mm Hg. EMG studies did not show a significant improvement comparing the 3HR with 6HR groups. There was a significant improvement in the EMG studies within the 3HR-F, when compared with 6HR-F. There was a trend toward sensory improvement between the 3HR-F and 3HR groups. However, this did not translate to a difference in functional outcome as measured by the Tarlov gait score. Conclusions: Within this swine model of hemorrhagic shock and hind limb ischemia, the use of prophylactic fasciotomies did not improve functional outcome.

AB - Background: Extremity injury, with concomitant hemorrhagic shock, can result in ischemia -reperfusion injury and the formation of compartment syndrome requiring fasciotomy. As the benefit of prophylactic fasciotomy is unclear, the objective of this study is to determine the functional recovery of an ischemic limb with hemorrhagic shock after prophylactic fasciotomy. Material and methods: Yorkshire swine underwent 35% blood volume hemorrhage, followed by 1, 3, and 6 h of ischemia (n = 17; 1HR, 3HR, and 6HR) via iliac artery occlusion followed by repair and reperfusion. A second cohort (n = 18) underwent fasciotomy of the anterior compartment of the hind limb following vascular repair (1HR-F, 3HR-F, and 6HR-F). Compartment pressures, measures of electromyographic (EMG) recovery, and a validated gait score (modified Tarlov) were performed throughout a 14-d survival period. Results: Increasing ischemic intervals resulted in incremental increases in compartment pressure (P <0.05), although the mean did not exceed 30 mm Hg. EMG studies did not show a significant improvement comparing the 3HR with 6HR groups. There was a significant improvement in the EMG studies within the 3HR-F, when compared with 6HR-F. There was a trend toward sensory improvement between the 3HR-F and 3HR groups. However, this did not translate to a difference in functional outcome as measured by the Tarlov gait score. Conclusions: Within this swine model of hemorrhagic shock and hind limb ischemia, the use of prophylactic fasciotomies did not improve functional outcome.

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