Austere Fasciotomy: Alternative Equipment for Performance in the Field.
Summary
Leg fasciotomies for acute compartment syndrome can be performed using alternative tools like rescue hooks and PenBlades when standard surgical instruments are unavailable. This study demonstrates the feasibility of using these devices in prehospital settings to save limbs.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Surgical Innovation
Background:
- Acute compartment syndrome (ACS) necessitates prompt fasciotomy to prevent limb loss.
- Prehospital fasciotomy may be required for trauma casualties unable to reach operating rooms.
- Traditional surgical tools may be unavailable in austere environments.
Purpose of the Study:
- To evaluate the efficacy of alternative instruments for performing leg fasciotomies.
- To compare the performance of rescue hooks and a PenBlade against standard surgical scissors.
- To assess potential iatrogenic injuries associated with alternative fasciotomy devices.
Main Methods:
- Four-compartment leg fasciotomies were performed on cadavers using scalpels and alternative instruments (rescue hooks, PenBlade).
- Instruments included Benchmade rescue hook, Leatherman Raptor, Leatherman Z-Rex, and PenBlade.
- Skin and fascia incision lengths were measured, and post-procedure dissections identified associated injuries.
Main Results:
- All tested devices successfully released the fascia in all four compartments.
- Rescue hooks required longer skin incisions than scissors or the PenBlade.
- One superficial peroneal nerve injury occurred with rescue hooks; no GSV or significant muscle injuries were noted.
Conclusions:
- Readily available alternative equipment, including rescue hooks and the PenBlade, can be used for four-compartment fasciotomy.
- Hook-type devices necessitate longer skin incisions compared to scissors and the PenBlade.
- Training prehospital medical personnel in the use of these alternative instruments can improve outcomes for patients with ACS in remote or combat settings.
