[Pathophysiology and pressure measurement in compartment syndrome]

Traumatic or ischemic damage of the musculature and soft tissue may cause compartment syndrome. In trauma, mechanical influences provoke humeral disorders and liberation of vasoactive substances with early onset of compartment syndrome, but isolated total ischemia of more than 6 h is commonly followed after revascularization by compartment syndrome caused by post-ischemic dilation of vessels. An understanding of the pathophysiology in compartment syndrome provides a better possibility of predicting this severe complication in trauma and vascular surgery patients. Several techniques are described for intracompartmental pressure monitoring. In normotensive patients, an intracompartmental pressure of more than 40 mmHg indicates "apparent" compartment syndrome, while pressures between 30 mmHg and 40 mmHg are interpreted as "imminent" compartment syndrome. In these cases therapeutic/prophylactic dermatofasciotomy is necessary. In hypotensive patients the lower limit for conducting a dermatofasciotomy must be reduced. According to the pathophysiology, an intracompartmental pressure of about 30 mmHg for more than 6 h duration must be treated by dermatofasciotomy.