今日の臨床サポート

コンパートメント症候群

著者: 松井健太郎 帝京大学 整形外科学講座 外傷センター

監修: 箕輪良行 みさと健和病院 救急総合診療研修顧問

著者校正/監修レビュー済:2022/05/25
患者向け説明資料

概要・推奨   

  1. コンパートメント症候群は、緊急手術での減圧が必要になる疾患である。
  1. 早期診断が重要である。
  1. 身体所見(緊満)と症状(損傷程度に見合わない強い疼痛やPassive stretch pain)で診断する。
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  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
松井健太郎 : 特に申告事項無し[2022年]
監修:箕輪良行 : 未申告[2022年]

改訂のポイント:
  1. 定期レビューを行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. コンパートメント(筋区画)症候群は緊急手術を要する疾患である。
  1. コンパートメント症候群では、外傷部位の腫脹が強くなりすぎた結果、問題が生じる。
  1. 原因として、骨折が多く、血管損傷、挫滅症候群、再灌流障害、横紋筋融解、熱傷、外部からの圧迫がある。
  1. 損傷を受けた筋肉などのコンパートメント内部の組織体積が増加し、コンパートメント内圧が上昇し、局所灌流障害などを呈する。
  1. コンパートメントは、骨、筋膜、筋間中隔に囲まれており、それに皮膚を含めたものがコンパートメントの容積を規定している。コンパートメント内には筋、神経、血管が存在する。
  1. 「早期診断」と「緊急筋膜切開による除圧」の可否が予後を左右する。
  1. 適切な治療が行われない場合、筋壊死、拘縮などが生じ、最悪の場合深部感染、切断を要する場合がある。
  1. 四肢いずれにも生じる(下腿、足部、前腕、手部、大腿、上腕)。
  1. 腹部コンパートメント症候群など、四肢以外にもコンパートメント症候群が生じる。
  1. 損傷形態と受傷機転からこの病態を想起し、臨床所見から診断することが重要である。
 
疫学:
  1. 発生数は年間10万人あたり3.1人。原因として最も多いものは骨折(69%)であり、骨折のなかでも脛骨骨幹端部(36%)、橈骨遠位部(9.8%)である。脛骨骨折に伴うコンパートメント症候群の合併率は2.7~11%である。開放骨折などのように開放創があるからといって、減圧されてコンパートメント症候群になりにくいわけではない[3][11][12]。まれではあるが、骨折整復後14~24時間で発症することもある[11][12]。上肢では、橈骨遠位端骨折に合併するもの、小児の顆上骨折がある。骨折に次いで、骨傷のない軟部損傷(23.3%)が多い。抗凝固薬を内服しているものが10%である。
問診・診察のポイント  
問診:
  1. 受傷日時を確認する。

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文献 

B Gulli, D Templeman
Compartment syndrome of the lower extremity.
Orthop Clin North Am. 1994 Oct;25(4):677-84.
Abstract/Text Compartment syndrome is a devastating consequence of extremity trauma that is preventable with early recognition and treatment. A high index of suspicion and careful clinical evaluation will detect most impending or established compartment syndromes. Compartmental pressure measurements can be a useful adjunctive evaluation. Once the diagnosis of compartment syndrome is confirmed, or highly suspect, fasciotomy should be performed without delay. The functional and cosmetic results of fasciotomy are always acceptable if done early. The results of inadequate treatment of compartment syndrome are never satisfactory.

PMID 8090479
E A Ouellette
Compartment syndromes in obtunded patients.
Hand Clin. 1998 Aug;14(3):431-50.
Abstract/Text A high index of suspicion for a compartment syndrome in the upper extremity should be maintained in all obtunded patients who are at risk for the condition. Obtunded patients are those with a dulled or altered physical or mental status secondary to injury, illness, or anesthesia; those with diminished or absent sensation in the upper extremity because of nerve injury or anesthesia; and those whose ability to communicate is impeded, such as infants and young children and the mentally ill or disabled. These patients represent a vulnerable group whose inability to demonstrate the hallmark symptoms and signs of the syndrome puts them in jeopardy of a late diagnosis of a compartment syndrome and its potentially devastating sequelae. The most likely causes of a compartment syndrome in this population are skeletal or soft-tissue trauma, prolonged limb compression, thrombolytic therapy after myocardial infarction, arterial or intravenous fluid administration, and upper extremity Surgery. Whenever a compartment syndrome of the hand, forearm, or upper arm is suspected, the obtunded patient should be examined closely and frequently, and any changes over time should be documented carefully. Intracompartmental pressure measurement provides a useful adjunct to the physical examination and history in these patients and may be diagnostic if other symptoms and signs are obscured. Once the compartment syndrome is diagnosed, emergent fasciotomy is indicated. To avoid a loss of function in the obtunded patient, special care must be taken postoperatively to assure that early motion exercises are carried out.

PMID 9742422
M M McQueen, C M Court-Brown
Compartment monitoring in tibial fractures. The pressure threshold for decompression.
J Bone Joint Surg Br. 1996 Jan;78(1):99-104.
Abstract/Text We made a prospective study of 116 patients with tibial diaphyseal fractures who had continuous monitoring of anterior compartment pressure for 24 hours. Three patients had acute compartment syndrome (2.6%). In the first 12 hours of monitoring, 53 patients had absolute pressures over 30 mmHg and 30 had pressures over 40 mmHg, with four higher than 50 mmHg. Only one patient had a differential pressure (diastolic minus compartment pressure) of less than 30 mmHg; he had a fasciotomy. In the second 12-hour period 28 patients had absolute pressures over 30 mmHg and seven over 40 mmHg. Only two had differential pressures of less than 30 mmHg; they had fasciotomies. None of our 116 patients had any sequelae of the compartment syndrome at their latest review at least six months after injury. A threshold for decompression of 30 mmHg would have indicated that 50 patients (43%) would have required fasciotomy, and at a 40 mmHg threshold 27 (23%) would have been considered for an unnecessary fasciotomy. In our series, the use of a differential pressure of 30 mmHg as a threshold for fasciotomy led to no missed cases of acute compartment syndrome. We recommended that decompression should be performed if the differential pressure level drops to under 30 mmHg.

PMID 8898137
S J Mubarak, A R Hargens, C A Owen, L P Garetto, W H Akeson
The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool.
J Bone Joint Surg Am. 1976 Oct;58(7):1016-20.
Abstract/Text The wick catheter technique was developed in 1968 for measurement of subcutaneous pressure and has been modified for easy intramuscular insertion and continuous recording of interstitial fluid pressure in animals and humans. Studies in dogs of the anterolateral compartment of the leg in simulation of the compartment syndrome showed the technique to be accurate and reproducible. The wick catheter technique is capable of important clinical applications in the diagnosis and treatment of acute and chronic compartment syndromes.

PMID 977611
D S Bae, R K Kadiyala, P M Waters
Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome.
J Pediatr Orthop. 2001 Sep-Oct;21(5):680-8.
Abstract/Text Compartment syndrome can be difficult to diagnose in a child, with delays in diagnosis leading to disastrous outcomes. Thirty-six cases of compartment syndrome in 33 pediatric patients were treated at the authors' institution from January 1, 1992, to December 31, 1997. There were 27 boys and 6 girls, with nearly equal upper and lower extremity involvement. Approximately 75% of these patients developed compartment syndrome in the setting of fracture. Pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms of compartment syndrome in these children. An increasing analgesia requirement in combination with other clinical signs, however, was a more sensitive indicator of compartment syndrome: all 10 patients with access to patient-controlled or nurse-administered analgesia during their initial evaluation demonstrated an increasing requirement for pain medication. With early diagnosis and expeditious treatment, >90% of the patients studied achieved full restoration of function.

PMID 11521042
Philip S Yuan, Maya E Pring, Tracey P Gaynor, Scott J Mubarak, Peter O Newton
Compartment syndrome following intramedullary fixation of pediatric forearm fractures.
J Pediatr Orthop. 2004 Jul-Aug;24(4):370-5.
Abstract/Text This study was designed to evaluate the incidence of compartment syndrome (CS) resulting from the treatment of both-bone forearm fractures in children. A retrospective analysis of 285 consecutive children who presented with both-bone forearm fractures was performed. Of 235 closed injuries, 205 were treated with closed reduction and casting; none of these patients developed CS. Thirty of the closed injuries were treated with closed reduction and intramedullary fixation; three of these patients (10%) developed CS. Fifty patients sustained open fractures and were treated with debridement and open reduction with intramedullary pinning; CS developed in three of these patients (6%). The eighty patients treated with intramedullary fixation had an increased incidence of CS compared with the 205 patients treated with closed reduction and casting (P < 0.001). Within the group of patients who had surgery, patients with longer operative times and more use of intraoperative fluoroscopy were at higher risk of developing CS.

Copyright 2004 Lippincott Williams and Wilkins
PMID 15205617
F A Matsen
Compartmental syndromes.
N Engl J Med. 1979 May 24;300(21):1210-1. doi: 10.1056/NEJM197905243002108.
Abstract/Text
PMID 431649
M J Allen, A J Stirling, C V Crawshaw, M R Barnes
Intracompartmental pressure monitoring of leg injuries. An aid to management.
J Bone Joint Surg Br. 1985 Jan;67(1):53-7.
Abstract/Text Acute compartment syndromes often develop insidiously and are often recognised too late to prevent permanent disability. Management is difficult as the compartment involved is seldom clinically apparent. By continuously monitoring the intracompartmental pressure these problems can be avoided: transient compartment syndromes can be differentiated from established ones and the correct compartment can be surgically decompressed. Pressure monitoring techniques were used in 28 patients; three developed a compartment syndrome requiring surgical intervention, seven had a temporary increase of pressure and in 18 the pressure remained unaltered. Of the three with compartment syndromes, one was unusual in that it affected the thigh and another, unique in our experience, affected both the thigh and the calf. Intracompartmental pressure monitoring significantly altered the management of two cases giving successful results with minimal intervention.

PMID 3968144
M M Heckman, T E Whitesides, S R Grewe, R L Judd, M Miller, J H Lawrence
Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model.
J Orthop Trauma. 1993;7(3):199-210.
Abstract/Text Our objective was to define the critical tissue pressure at which irreversible muscle damage occurs and to compare our results to those thresholds advocated in the orthopaedic literature. A standard plasma infusion compartment syndrome model was created in a canine model. Four dogs were in each of four experimental groups with compartment pressure maintained as follows: (a) 30 mm Hg with support of diastolic blood pressure to a level > 50 mm Hg; (b) 20 mm Hg less than diastolic pressure; (c) 10 mm Hg less than diastolic blood pressure; (d) a level equal to the animal's diastolic blood pressure. All animals were sacrificed 14 days after the procedure. Histology revealed the following: (a) tissues pressurized to 30 mm Hg in a normotensive dog demonstrated no significant abnormalities; (b) tissues pressurized to 20 mm Hg less than diastolic revealed occasional cells undergoing regeneration but no evidence of infarction or fibrosis; (c) tissues pressurized to 10 mm Hg less than diastolic showed scattered small areas of infarction and fibrosis; and (d) tissues pressurized to diastolic blood pressure demonstrated more widespread infarction and scarring. The ischemic threshold of muscle, beyond which irreversible tissue damage occurs, is directly related to the difference in compartment and perfusion pressure. Our findings document this pressure to be 10 mm Hg less than diastolic blood pressure or within 30 mm Hg of mean arterial pressure. This data refutes the use of absolute tissue pressure values as a guide to the necessity of fasciotomy. To abort an impending compartment syndrome and avoid irreversible tissue injury and their sequelae, fasciotomy should be done if tissue pressure reaches within 10-20 mm Hg of diastolic pressure.

PMID 8326422
M J Matava, T E Whitesides, J G Seiler, K Hewan-Lowe, W C Hutton
Determination of the compartment pressure threshold of muscle ischemia in a canine model.
J Trauma. 1994 Jul;37(1):50-8.
Abstract/Text A canine model was used to test the hypothesis that critical intracompartmental pressure leading to ischemic muscle necrosis is linked to diastolic blood pressure. Twenty adult dogs were subjected to an infusion of autologous plasma into the anterolateral muscle compartment of the left hindlimb to create an elevation in compartment pressure. There were four experimental groups of five dogs each. In group I, the compartment pressure (CP) was maintained at the animals' diastolic blood pressure (DBP); in group II, at 10 mm Hg less than the DBP; in group III, at 20 mm Hg less than the DBP; and in group IV, at 30 mm Hg. The pressure was measured continuously in the proximal, central, and distal segments of the compartment during an 8-hour period. Immediately postoperatively, and, on the first, fourth, seventh, and fourteenth days one animal from each group was killed. The tibialis cranialis muscle was then removed and analyzed using light and electron microscopy. The critical pressure threshold for ischemic muscle necrosis was found to be 20 mm Hg less than the diastolic blood pressure.

PMID 8028059
M M McQueen, P Gaston, C M Court-Brown
Acute compartment syndrome. Who is at risk?
J Bone Joint Surg Br. 2000 Mar;82(2):200-3.
Abstract/Text We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.

PMID 10755426
M M McQueen, J Christie, C M Court-Brown
Acute compartment syndrome in tibial diaphyseal fractures.
J Bone Joint Surg Br. 1996 Jan;78(1):95-8.
Abstract/Text We reviewed 25 patients with tibial diaphyseal fractures which had been complicated by an acute compartment syndrome. Thirteen had undergone continuous monitoring of the compartment pressure and the other 12 had not. The average delay from injury to fasciotomy in the monitored group was 16 hours and in the non-monitored group 32 hours (p < 0.05). Of the 12 surviving patients in the monitored group, none had any sequelae of acute compartment syndrome at final review at an average of 10.5 months. Of the 11 surviving patients in the non-monitored group, ten had definite sequelae with muscle weakness and contractures (p < 0.01). There was also a significant delay in tibial union in the non-monitored group (p < 0.05). We recommend that, when equipment is available, all patients with tibial fractures should have continuous compartment monitoring to minimise the incidence of acute compartment syndrome.

PMID 8898136
George C Velmahos, Konstantinos G Toutouzas
Vascular trauma and compartment syndromes.
Surg Clin North Am. 2002 Feb;82(1):125-41, xxi. doi: 10.1016/S0039-6109(03)00145-2.
Abstract/Text Vascular injuries produce ischemia, and their repair produces reperfusion. Ischemia and reperfusion produce compartment syndrome. Although a local event, a compartment syndrome risks not only the affected extremity, but also the life of the patient. A high index of suspicion coupled with adequate knowledge of subtle clinical symptoms (and confirmed by intracompartmental pressure measurement) improve management of compartment syndrome, and this article discusses common pitfalls in its diagnosis and treatment.

PMID 11905942
TE Whitesides, MM Heckman
Acute Compartment Syndrome: Update on Diagnosis and Treatment.
J Am Acad Orthop Surg. 1996 Jul;4(4):209-218.
Abstract/Text Acute compartment syndrome can have disastrous consequences. Because unusual pain may be the only symptom of an impending problem, a high index of suspicion, accurate evaluation, and prophylactic treatment will allow the physician to intervene in a timely manner and prevent irreversible damage. Muscles tolerate 4 hours of ischemia well, but by 6 hours the result is uncertain; after 8 hours, the damage is irreversible. Ischemic injury begins when tissue pressure is 10 to 20 mm Hg below diastolic pressure. Therefore, fasciotomy generally should be done when tissue pressure rises past 20 mm Hg below diastolic pressure.

PMID 10795056
T E Whitesides, T C Haney, K Morimoto, H Harada
Tissue pressure measurements as a determinant for the need of fasciotomy.
Clin Orthop Relat Res. 1975 Nov-Dec;(113):43-51.
Abstract/Text An experimental and clinical tehcnique of measuring tissue pressures within closed compartments demonstrates a normal tissue pressure is approximately zero mmHg, and increased markedly in compartmental syndromes. There is inadequate perfusion and relative ischemia when the tissue pressure within a closed compartment rises to within 10-30 mm Hg of the patient's diastolic blood pressure. Fasciotomy is usually indicated, therefore, when the tissue pressure rises to 40-45 mm Hg in a patient with a diastolic blood pressure of 70 mm Hg and any of the signs or symptoms of a compartmental syndrome. There is no effective tissue perfusion within a closed compartment when the tissue pressure equals or exceeds the patient's diastolic blood pressure. A fasciotomy is definitely indicated in this circumstance, although distal pulses may be present. The measurement of tissue pressure aids in the early diagnosis and appropriate treatment of compartmental syndromes.

PMID 1192674
Abstract/Text An experimental model of acute compartment syndrome involving the anterolateral compartment of the hindlimb in dogs was used to compare three methods of measurement of intracompartmental pressure: the simple-needle technique, use of the slit catheter, and use of the side-ported needle. No statistical difference was found between the values obtained with the slit catheter and those obtained with the side-ported needle; the mean difference was 1.4 millimeters of mercury throughout the range of compartment pressures that were measured. The side-ported needle appeared to be as accurate as the slit catheter for the measurement of compartment pressures (p = 0.355, 1-beta = 0.9). The values obtained with use of the simple needle were consistently higher than those obtained with the other two methods (p < 0.001): an average of 18.3 millimeters of mercury higher than the values measured with the slit catheter and 19.3 millimeters of mercury higher than those measured with the side-ported needle. Clinically, the side-ported needle or the slit catheter can be used to obtain accurate measurements of compartment pressure. Use of the simple 18-gauge needle is not recommended for this purpose.

PMID 8423183
Antony R Boody, Montri D Wongworawat
Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices.
J Bone Joint Surg Am. 2005 Nov;87(11):2415-22. doi: 10.2106/JBJS.D.02826.
Abstract/Text BACKGROUND: In situations in which accurate physical diagnosis is inconclusive, an objective method for measuring compartment pressure can aid in the diagnosis of compartment syndrome. Previous studies have compared measurement devices with each other but not with an accurately determined gold standard. The purpose of the present study was to devise a reproducible in vitro model of compartment pressure and to compare commonly used measurement devices in order to determine their accuracy.
METHODS: With a graduated cylinder being used to generate a known pressure, freshly harvested ovine muscle was placed into a chamber for testing. The cylinder was incrementally filled with saline solution (in fifty-five steps), and measurements of tissue pressure were obtained with use of the Stryker Intracompartmental Pressure Monitor System, an arterial line manometer, and the Whitesides apparatus. Each device was tested with a straight needle, a side-port needle, and a slit catheter, for a total of nine setups in all. Five trials were done with each setup. Control pressures were calculated on the basis of the height of the saline solution column (test range, 0.13 to 10.80 kPa). Multiple regression analysis was used to compare measured tissue pressures with calculated control pressures.
RESULTS: Most methods demonstrated excellent correlation (R2> 0.95) between calculated and measured pressures. The arterial line manometer with the slit catheter showed the best correlation (R2= 0.9978), and the Whitesides apparatus with the side-port needle showed the worst (R2= 0.9115). Furthermore, the Stryker system with the side-port needle demonstrated the least constant bias (+0.06 kPa). Straight needles tended to overestimate pressure. Two of the three needle configurations involving the Whitesides apparatus overestimated pressure. The data for the Whitesides methods had the highest standard errors, showing clinically unacceptable scatter.
CONCLUSION: Side-port needles and slit catheters are more accurate than straight needles are. The arterial line manometer is the most accurate device. The Stryker device is also very accurate. The Whitesides manometer apparatus lacks the precision needed for clinical use.

PMID 16264116
N D Reis, M Michaelson
Crush injury to the lower limbs. Treatment of the local injury.
J Bone Joint Surg Am. 1986 Mar;68(3):414-8.
Abstract/Text We treated fifteen patients who had been trapped under the masonry of collapsed buildings for various periods of time. In one group of patients who had been buried for twelve hours, treatment commenced only twenty-four hours after the injury, and the other group was treated more promptly. In the second group, the success of forced diuresis and alkalinization of the urine in preventing the renal complications of the crush syndrome was evident. A reassessment of the treatment of the local lesion was made and a scheme of treatment is proposed. The injury is essentially closed, and incomplete excision of the necrotic muscle is fraught with risk. Local rigor in the affected muscles is important.

PMID 3949835
G W Sheridan, F A Matsen
Fasciotomy in the treatment of the acute compartment syndrome.
J Bone Joint Surg Am. 1976 Jan;58(1):112-5.
Abstract/Text Sixty-six cases of acute compartment syndrome were treated by fasciotomy in forty-six extremities of forty-four patients. Fasciotomy performed early, that is, less than twelve hours after the onset of the compartment syndrome, resulted in normal function in 68 per cent of the extremities. Only 8 per cent of those having late fasciotomy had normal function. The complication rates for the early and late fasciotomized extremities were 4.5 per cent and 54 per cent, respectively. No significant differences in residual function or complication rate were noted with "open" or "closed" fasciotomy.

PMID 1249096
J A Finkelstein, G A Hunter, R W Hu
Lower limb compartment syndrome: course after delayed fasciotomy.
J Trauma. 1996 Mar;40(3):342-4.
Abstract/Text OBJECTIVE: To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome.
DESIGN: A retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should ideally have been performed earlier.
MATERIALS AND METHODS: Nine fasciotomies in five patients were identified where there was a delay of more than 35 hours after the injury. The average ischemic time was 56 hours (range 35-96 hours).
RESULTS: One patient died of multiorgan failure and septicemia. The remaining four patients required lower limb amputation, because of local infection and septicemia. The one late amputation was performed 6 months after the injury, because the patient was left with a functionless insensate foot. Where recognition of an established compartment syndrome is delayed for more than 8 to 10 hours, we propose that the traditional inevitable fasciotomy be reassessed.

PMID 8601846
A M Fitzgerald, P Gaston, Y Wilson, A Quaba, M M McQueen
Long-term sequelae of fasciotomy wounds.
Br J Plast Surg. 2000 Dec;53(8):690-3. doi: 10.1054/bjps.2000.3444.
Abstract/Text A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

Copyright 2000 The British Association of Plastic Surgeons.
PMID 11090326

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以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから