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The Impact of Circumferential Dressings on Muscle Compartment Pressure: Results From Synthetic and Cadaveric Models
Vivian E Kwok1, Daniel J M Rohde1, Dana Hazem2
1Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, United States.
Introduction:
Circumferential dressings applied over injured extremities can elevate muscle compartment pressure (MCP), increasing the risk of reaching the tipping point for acute compartment syndrome (ACS), a surgical emergency that can cause permanent tissue damage or even limb loss. We hypothesized that use of highly elastic dressings would show the largest increase in MCP.
Materials And Methods:
A synthetic model (mannequin arm wrapped with a silicon sleeve) and 2 cadaveric models (foot to thigh with and without a long leg splint) were pressurized with saline (synthetic) or oil (cadaveric) to physiologic pressures. A pressure sensor was inserted into the silicone sleeve and the anterior and superficial posterior compartments of the cadaveric leg to provide continuous MCP measurements in mmHg. Low stretch (LS), moderate stretch (MS), and high stretch (HS) dressings were applied circumferentially by clinicians. Prewrap and postwrap MCPs were recorded. Average increase in MCP was calculated, and differences among dressings were assessed using ANOVA.
Results:
There was a significant difference among the 3 dressings in the synthetic model (P = .00044), and the mean pressure differences for the LS, MS, and HS dressings were 2.18 ± 1.13 mmHg (n = 8), 4.51 ± 1.69 mmHg (n = 7), and 5.81 ± 1.36 mmHg (n = 6), respectively. The cadaveric no-splint model showed significance in the anterior compartment (P = .017), with mean pressure differences of 3.01 ± 1.56 mmHg (n = 5) for LS, 9.02 ± 4.35 mmHg (n = 6) for MS, and 10.66 ± 4.82 mmHg (n = 6) for HS dressing. This significance was not captured with the addition of a splint. Mean pressure change among the 3 dressings were not significant in the posterior compartment in either cadaveric model. Among all experimental models, the LS displayed the least amount of MCP change compared to that of MS and HS.
Conclusion:
Clinicians should consider both dressing type and the use of splints when managing patients at risk for ACS. Future studies are needed to confirm whether these experimental findings translate into differences in clinical outcomes, especially in high-risk scenarios.
