4 compartments of leg skin#

4 compartments of leg skin#

Careful use of elastic retention sutures (elastic vessel loop woven through skin staples) can help counteract skin contraction, and be tightened progressively as swelling resolves. This is only permissible if it can be achieved without any skin tension it is inadvisable in smokers, who have impaired capacity for soft-tissue healing.įasciotomy wound edges tend to retract and become difficult to close. It is tempting to the surgeon to try early secondary skin suture, rather than skin-graft coverage, once the swelling has subsided. The simplest and safest technique is to cover the healthy soft-tissue defect with a split skin graft: at a later date, when the limb contours have returned to normal, the grafted area can be excised and secondary skin closure performed without tension. Once any skeletal injury is under control, the fasciotomy wound(s) healthy and the swelling of the soft tissues has sufficiently regressed, consideration must be given to achieving skin coverage. Reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. An arterial injury may cause compartmental tissue ischemia.Muscle tolerates short periods of hypoxia, but after a few hours, progressive necrosis begins.The axial T1-weighted image (4A) suggests slight bowing of the fascia over the anterior and lateral compartments. (MPP has also been called 'Delta P', to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. Figure 4: Images from an MR examination of the left leg obtained on a 45 year-old male with pain in the proximal to mid portions of the leg. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure.if diastolic arterial pressure is not more than 30 mm Hg above tissue pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue.The posterior compartment is usually divided in two layers: superficial and deep. In total, there are 13 separate muscles across these three compartments. The muscles of the leg are divided into three compartments: the anterior compartment, the posterior compartment and the lateral compartment.

When tissue pressure approaches the diastolic pressure, capillary blood flow ceases. The leg muscles are organized in anterior, lateral and posterior compartments. The leg is defined anatomically as the portion of the lower limb from the knee joint to the ankle joint.

The capillary filling pressure is essentially diastolic arterial pressure. This critical level is the tissue pressure which collapses the capillary bed and prevents low-pressure blood flow through the capillaries and into the venous drainage.

Compartment syndrome occurs when the pressure within a closed osteo-fascial muscle compartment rises above a critical level.