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Introduction: Traumatic pseudoaneurysms of the limbs are rare, with few cases described in vascular literature. Treatment is variable and dependent upon presentation and impact on local anatomy affected. Rapid assessment can be performed with ultrasound and assist in treatment decisions. We describe a case of traumatic anterior tibial artery pseudoaneurysm, which was rapidly identified with point-of-care ultrasound leading to definitive surgical management.Case Report: A 37-year-old female presented to the emergency department for evaluation of right lower extremity pain and swelling following an exercise session with weighted squats and thigh abductor machines. She was found to have an anterior tibial artery pseudoaneurysm on point-of-care ultrasound, later confirmed with formal ultrasound as well as angiography, and was admitted for surgical management.Conclusion: Traumatic pseudoaneurysms can rapidly be differentiated from other mass lesions and contributors to compartment syndrome using point-of-care ultrasound.

El síndrome compartimental constituye una emergencia de tipo quirúrgico la cual requiere de un diagnóstico y abordaje tempranamente oportuno con el fin de disminuir la aparición de posibles secuelas y complicaciones. Las manifestaciones clínicas de dicha patología son amplias sin embargo el signo pivote es la presencia de dolor desmedido en relación con la lesión física presente. La realización de la fasciotomía, de manera temprana, es la medida terapéutica ideal tanto para aliviar la sintomatología del paciente como evitar la aparición de secuelas., Compartment syndrome constitutes a qururigo-type emergency, which requires an early diagnosis and timely approach in order to reduce the appearance of possible sequelae and complications. The clinical manifestations of this pathology are extensive, however the pivotal sign is the presence of excessive pain in relation to the physical injury. Performing fasciotomy, early, is the ideal therapeutic measure both to alleviate the patient's symptoms and to avoid sequelae.

BackgroundThe purpose of this study was to evaluate the incidence of lower extremity compartment syndrome in National Football League (NFL) athletes and report the mechanisms of injury, methods of treatment, and subsequent days missed. We review the existing literature on lower extremity compartment syndrome in athletic populations.HypothesisLower extremity compartment syndrome occurs with a low incidence in NFL athletes, and there is a high return-to-play rate after surgical management of acute compartment syndrome.Study designCase series.Level of evidenceLevel 4.MethodsA retrospective review of recorded cases of lower extremity compartment syndrome from 2000 to 2017 was performed using the NFL Injury Surveillance System and electronic medical record system. Epidemiological data, injury mechanism, rates of surgery, and days missed due to injury were recorded.ResultsDuring the study period, 22 cases of leg compartment syndrome in 21 athletes were recorded. Of these injuries, 50% occurred in games and 73% were the result of a direct impact to the leg. Concomitant tibial fracture was noted in only 2 cases (9.1%) and there was only 1 reported case of chronic exertional compartment syndrome. Surgery was documented in 15 of 22 cases (68.2%). For acute nonfracture cases, the average time missed due to injury was 24.2 days (range, 5-54 days), and all were able to return to full participation within the same season.ConclusionNFL athletes with acute leg compartment syndrome treated with surgery exhibited a high rate of return to play within the same season.Clinical relevanceAlthough compartment syndrome is a relatively rare diagnosis among NFL players, team physicians and athletic trainers must maintain a high index of suspicion to expediently diagnose and treat this potentially limb-threatening condition.

Introduction: The management of VPT(vascular peripheral trauma) surrounds the necessity to avoid compartment syndrome, within its early management is to perform fasciotomies which have not been well defined in international guidelines. We evaluated the outcomes of patients with surgically treated peripheral arterial injury who underwent early fasciotomies. Methods: An observational retrospective study of patients with VPT who were taken to early fasciotomy. Exclusion criteria were, head or spinal cord injuries, crush injuries, burn injuries, and declaration of death on arrival. Comparative analyses of demographics, injury characteristics, complications, and outcomes were performed. Results: In a period of 6 years, 17 patients with VPT were treated with an early fasciotomy, (35%) with vascular lesion of the femoral artery, (59%) vascular injury of the humeral, (6%) case of concomitant lesion of the vein and popliteal artery. Regarding management (76%) complete early fasciotomies and (24%) limited, of the total number of patients, in 10 (59%) two fasciotomies were performed. Conclusion: The decision to perform early fasciotomy should be based on the risk of compartment syndrome and the patient's condition, patients with early fasciotomy performed at the same surgical time as vascular reconstruction have shown greater benefits., Introducción: El manejo del TVP (trauma vascular periferico) circunda la necesidad de evitar el síndrome compartimental, dentro de su manejo temprano se encuentra realizar fasciotomías las cuales no han sido definidas en guías internacionales. Se evaluaron los resultados de los pacientes con lesión arterial periférica tratada quirúrgicamente que se sometieron a fasciotomías tempranas. Métodos: Estudio retrospectivo observacional de pacientes con trauma vascular de periférico que fueron llevados a fasciotomía tempranas. Los criterios de exclusión fueron lesiones craneoencefálicas o de médula espinal, lesiones por aplastamiento, lesiones por quemaduras y declaración de muerte a la llegada. Se realizaron análisis comparativos de la demografía, características de las lesiones, complicaciones y resultados. Resultados: En un periodo de 6 años se manejaron 17 pacientes con TVP llevados a fasciotomía temprana, (35%) con lesión vascular de la arteria femoral, (59%) casos lesión vascular de la humeral, (6%) caso lesión concomitante de vena y arteria poplítea. Respecto al manejo (76%) fasciotomías temprana completas y (24%) limitadas, del total de pacientes, en 10 (59%) se realizaron dos fasciotomías. Conclusión: La decisión de realizar fasciotomía temprana debe basarse en el riesgo de síndrome compartimental y el estado del paciente, los pacientes con fasciotomía temprana realizada en el mismo tiempo quirúrgico que la reconstrucción vascular han mostrado mayores beneficios.

Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia,the activity of toxins or in patients with tissue ischemia or muscle necrosis. Clinical findings have found pronounced pain, followed by paresthesias, pallor, and paresis. Decreased pulsation of arteries has also been a frequent finding. In severe forms decompressive fasciotomy has been indicated within the first 12–24 hours after diagnosis. In the following paper, the authors present the case report of a 68-year woman who swallowed 1500 mg of trazodone as an attempt at suicide. After 12 hours her husband found her lying on the carpet with compression of the left arm under the trunk. The patient was treated conservatively and followed clinically,examined by ultrasonography, EMG and finally MRI., ‎Syndrom akutního kompartmentu se vyskytuje nejčastěji v souvislosti se zraněními, terminálním nebo chemickým poškozením tkání, ischemií, aktivitou toxinů nebo u pacientů s tkáňovou ischemií nebo svalovou nekrózou. Klinické nálezy zjistily výraznou bolest, následovanou parestézií, bledost a parézou. Častým nálezem byla také snížená pulzace tepn. V těžkých formách byla dekompresní fasciotomie indikována během prvních 12-24 hodin po diagnóze. V následujícím článku autoři prezentují případovou zprávu 68leté ženy, která spolkla 1500 mg trazodonu jako pokus o sebevraždu. Po 12 hodinách ji manžel našel ležet na koberci s kompresí levé paže pod kufrem. Pacient byl léčen konzervativně a klinicky sledován, vyšetřen ultrasonografií, EMG a nakonec MRI.‎

The article presents the biochemical mechanism of narcotic and toxic effects of ethyl alcohol on the human body, lists the life-threatening complications of chronic abuse of ethyl alcohol with a focus on the compartment syndrome. At the end of the article, a clinical observation is presented, in which the compartment syndrome was masked under the diagnosis of acute cerebrovascular accident for a week, and the patient recovered after three sessions of renal replacement therapy. Attention is drawn to the need for a thorough external examination of patients with alcohol intoxication. All patients admitted to the clinic with acute alcohol intoxication should be screened for rhabdomyolysis., В статье представлен биохимический механизм наркотического и токсического действия этилового алкоголя на организм человека, перечислены жизненно опасные ­осложнения хронического злоупотребления этиловым алко­голем с акцентом на синдром позиционного сдавления. В конце статьи приведено клиническое наблюдение, в котором на протяжении недели синдром позиционного сдавления маскировался под диагноз «острое нарушение мозгового кровообращения» и завершился выздоровлением больной после проведения трех сеансов заместительной почечной терапии. Акцентируется внимание на необходимости тщательного ежедневного внешнего осмотра пациентов с алкогольной интоксикацией. Все пациенты, поступающие в клинику в состоянии острой алкогольной интоксикации, должны быть обследованы на предмет наличия у них рабдомиолиза., У статті описаний біохімічний механізм наркотичної і токсичної дії етилового алкоголю на організм людини, перераховані життєво небезпечні ускладнення хронічного зловживання етиловим алкоголем з акцентом на синдром позиційного стиснення. У кінці статті наведене клінічне спостереження, де упродовж тижня синдром позиційного стиснення маскувався під діагнозом «гостре порушення мозкового кровообігу» і завершився одужанням хворої після проведення трьох сеансів замісної ниркової терапії. Акцентується увага на необхідності ретельного зовнішнього огляду пацієнтів з алкогольною інтоксикацією. Усі пацієнти, які надходять у клініку в стані гострої алкогольної інтоксикації, повинні бути обстежені на предмет наявності в них рабдоміолізу.

ObjectiveThe aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture.MethodsData from the National Trauma Data Bank for the years 2004-2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy.ResultsA total of 1.22% of the forearm fractures and 3.79% of the tibial fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (P < 0.0001); have injuries resulting from machinery, motor vehicle collisions, and firearms (P < 0.0001); and smoke, use drugs, and/or alcohol (P < 0.05) compared with patients who did not undergo fasciotomies. Fasciotomy procedures were associated with longer LOS and higher mortality rate (P < 0.05).ConclusionsThe incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology.Level of evidencePrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Amniotic band sequence (ABS) is a group of congenital anomalies caused by in utero trauma from fibrous amniotic bands. ABS can rarely cause areas of absent skin at birth or Aplasia cutis congenita (ACC). We report a case of an otherwise healthy term male neonate, born via normal vaginal delivery, who presents at birth with extensive ACC of the right forearm and proximal hand. This is associated with underlying absence of subcutaneous tissue and muscle at the site and a congenital radial head dislocation. The neonate has a resting flexion deformity of the wrist and fingers due to the significant involvement of the extensor compartment of the forearm. The antenatal history was unremarkable with no maternal history of medications or infections during the pregnancy. There was no significant family history, including that of vascular disorders or ACC. The differential of Volkmann's ischemic contracture (VIC) was excluded due to the presentation. VIC is characterised by the rapid evolution of deep rupturing bullae which ulcerate and nectrotise due to ischemia from compartment syndrome that requires urgent fasciotomy. The remainder of the physical examination revealed no other abnormalities. Thus, associated syndromes with ACC (including Adams-Oliver, Bart and Setleis) were also excluded. Over the last six months, early and regular splinting, dressings and hand therapy have enabled continuing improvement in functioning of the hand. Large ACCs are typically managed with non-adherent dressings to conserve a moist environment and provide a physical barrier from pathogens and possible trauma. The contractures formed from the atrophic scarring may require future surgical intervention if current conservative measures begin to fail. This case highlights that timely recognition of this rare association and early aggressive intervention with splinting, hand therapy and appropriate dressings optimises outcome.

Because of disabling sequelae of open fasciotomy in anterior compartment syndrome (ACS) of the leg, we wanted to describe and validate a cadaveric model of ACS. We hypothesized that, first, anterior compartment syndrome (ACS) could be reproduced in cadaveric leg and, second, fasciotomy without complete skin incision could lower the intramuscular pressure (IMP) in an equivalent range to complete dermatofasciotomy. Lower limb ACS was reproduced by progressive injection of physiologic serum in the anterior compartment of 23 fresh frozen cadaveric legs with monitoring of IMP, in order to reach a maximal stabilised IMP higher than 30mmHg. Subcutaneous minimally invasive fasciotomy was performed on 14 legs through 5 transversal mini-incisions of the skin (2cm) along the axis from the tibial tuberosity to the posterior aspect of the lateral malleolus. Standard open fasciotomy of the anterior compartment was performed on the remaining 9 legs as control. IMP was measured after the skin incisions and after every fasciotomy through skin incisions in the first group and after skin and fascia incisions in the control group. A maximal IMP of 43±2mmHg was obtained by injection of 177±9ml physiologic serum into the anterior compartment of the leg. In the control open fasciotomy group, the skin incision alone did not lower IMP significantly, whereas fasciotomy lowered IMP to 10±1mmHg, which is statistically different from maximal IMP (p<0.001). In the subcutaneous fasciotomy group, complete fasciotomy lowered significantly the IMP to 11±4mmHg (p<0.001), without statistical difference with the control group. This cadaveric model is effective to reproduce the hyperpressure encountered in ACS. In this model, IMP release after fasciotomy is as efficient through minimally invasive subcutaneous incision as with control open fasciotomy. This in vitro technique appears as an attractive alternative treatment in anterior compartment syndrome of the leg. It should be tested in the other compar

Amniotic band sequence (ABS) is a group of congenital anomalies caused by in utero trauma from fibrous amniotic bands. ABS can rarely cause areas of absent skin at birth or Aplasia cutis congenita (ACC). We report a case of an otherwise healthy term male neonate, born via normal vaginal delivery, who presents at birth with extensive ACC of the right forearm and proximal hand. This is associated with underlying absence of subcutaneous tissue and muscle at the site and a congenital radial head dislocation. The neonate has a resting flexion deformity of the wrist and fingers due to the significant involvement of the extensor compartment of the forearm. The antenatal history was unremarkable with no maternal history of medications or infections during the pregnancy. There was no significant family history, including that of vascular disorders or ACC. The differential of Volkmann's ischemic contracture (VIC) was excluded due to the presentation. VIC is characterised by the rapid evolution of deep rupturing bullae which ulcerate and nectrotise due to ischemia from compartment syndrome that requires urgent fasciotomy. The remainder of the physical examination revealed no other abnormalities. Thus, associated syndromes with ACC (including Adams-Oliver, Bart and Setleis) were also excluded. Over the last six months, early and regular splinting, dressings and hand therapy have enabled continuing improvement in functioning of the hand. Large ACCs are typically managed with non-adherent dressings to conserve a moist environment and provide a physical barrier from pathogens and possible trauma. The contractures formed from the atrophic scarring may require future surgical intervention if current conservative measures begin to fail. This case highlights that timely recognition of this rare association and early aggressive intervention with splinting, hand therapy and appropriate dressings optimises outcome.

Thoracic injuries are the most lethal penetrating injuries. After attempting suicide, two patients with a penetrating thoracic wound were admitted to our emergency department. During CT scan they became hemodynamically unstable, which is why we had to perform an emergency thoracotomy.In both cases, a perforation in the left ventricle as well as multiple lesions of the lung parenchyma and vessel injuries were found. After the treatment of the different injuries, a massive edema of the heart and lung prevented a primary closure of the thorax. Due to massive diffuse bleeding, a "packing" of the pleural cavity became necessary. To prevent a thoracic compartment syndrome, the thoracic wall was left open and the skin was closed with a plastic sheet. Due to the "open chest" procedure combined with "packing" of the thoracic cavity, the majority of patients with an edema of the heart and lung after a penetrating chest injury can be saved. Pitfalls of preclinical and clinical treatment, aspects of diagnostics and surgery are discussed., Thorakale Verletzungen sind die tödlichsten penetrierenden Verletzungen.Zwei Patienten wurden nach einem Suizidversuch mit einer penetrierenden Thoraxverletzung in unsere Notaufnahme eingeliefert. Während der CT-Untersuchung kam es zu einer Kreislaufdekompensation, so dass die notfallmäßige Thorakotomie erfolgen musste. In beiden Fällen fand sich eine Perforation im linken Ventrikel neben multiplen Lungenparenchym- und Gefäßverletzungen. Nach Versorgung der verschiedenen Läsionen verhinderte ein massives Ödem des Herzens und der Lunge einen Primärverschluss des Thorax, wobei wegen diffuser Blutung noch ein "Packing" der Thoraxhöhle notwendig wurde. Zur Prävention eines Kompartmentsyndroms blieb der knöcherne Thorax offen und es wurde nur die Haut mit einer Plastikfolie verschlossen. Aufgrund der Kombination des offen belassenen Thorax und des Austamponierens der Thoraxhöhle kann die Mehrzahl der Patienten mit einem Herz-Lungen-Ödem nach penetrierender Verletzung gerettet werden.Fallstricke der präklinischen und klinischen Behandlung sowie Aspekte der Diagnostik und Operation werden diskutiert.

Chronic exertional compartment syndrome (CECS) of the forearm is uncommon and has been described in association with sport and work-related activities. We describe the uncommon presentation of a patient with CECS of the forearm who was treated through a min-invasive fasciotomy. CECS of the forearm must be suspected in patients with compartmental pain even if they do not practice risk activities. Mini-invasive fasciotomy is an effective option for the treatment of this pathology., El síndrome compartimental crónico inducido por el ejercicio o el uso excesivo raramente afecta a los miembros superiores y se ha relacionado con actividades deportivas o laborales. Describimos un caso de un paciente con diagnóstico de síndrome compartimental crónico de antebrazo, de características poco habituales, tratado con fasciotomía mínimamente invasiva. Este síndrome debe sospecharse incluso en pacientes que no practiquen actividades de riesgo y que sufran dolor compartimental inespecífico. La fasciotomía con técnica mínimamente invasiva es una opción eficaz para curar este cuadro. ABSTRACTChronic exertional compartment syndrome (CECS) of the forearm is uncommon and has been described in association with sport and work-related activities. We describe the uncommon presentation of a patient with CECS of the forearm who was treated through a min-invasive fasciotomy. CECS of the forearm must be suspected in patients with compartmental pain even if they do not practice risk activities. Mini-invasive fasciotomy is an effective option for the treatment of this pathology.

Introduction: Muscle changes in patients with diabetes and lower leg pain due to chronic exertional compartment syndrome (CECS) were investigated before and after fasciotomy. Methods: The tibialis anterior muscle was analyzed with histochemical and morphological techniques in 7 patients with diabetes and CECS before fasciotomy and in 5 of them 1 year after fasciotomy. Nondiabetic patients with CECS and healthy participants served as references. Results: Before treatment, walking distance until occurrence of pain was limited (<0.2 km). Intramuscular pressure was significantly higher than in reference participants. Muscle analysis showed changes pathognomonic for neuropathy and myopathy and a restricted capillary network, with significantly more severe changes in the muscles of patients with diabetes than in the muscles of nondiabetic patients. Treatment with fasciotomy improved clinical signs, increased walking ability, and reduced muscle abnormalities, but muscle capillarization remained low. Discussion: Patients with diabetes and CECS have distinct pathological changes in affected muscles. Pressure-relieving fasciotomy triggers a regenerative response in the muscle tissue but not in the capillary bed.

Acute ST elevation myocardial infarction (STEMI) is a very rare complication post orthotopic heart transplantation. There are only limited data regarding pathophysiological mechanisms and early occurrence of STEMI in heart transplant recipients. Background(s): We describe a 45-year-old Caucasian man with severe dilated cardiomyopathy, on approximately nine months left ventricular assist device (LVAD), and a temporary right ventricular assist device (RVAD) as a bridge to cardiac transplantation. He received the organ from a 48-year-old male with no cardiac risk factors. The donor's heart had normal left ventricular (LV) ejection fraction, accordingly the presence of coronary heart disease was not tested before transplantation. The total ischaemic time was about 210 minutes. On day one post operation, he suffered left leg compartment syndrome requiring urgent fasciotomy 48 hours post-transplant, he developed a progressive reduction of cardiac output and the incremental need for inotropic support. Electrocardiogram revealed inferolateral ST elevations associated with raised troponin I (93ug/L) and echocardiogram showed severe LV dysfunction with inferolateral and inferior wall akinesia. Result(s): Percutaneous coronary intervention (PCI) and drug eluting stent insertion in the left circumflex coronary artery was successfully performed. (Fig. 1) Subsequent endomyocardial biopsy showed International Society for Heart and Lung Transplantation grade 0R and he survived after a prolonged hospital admission with minor clinical sequelae. [Figure Presented] Conclusion(s): In reviewing the pathophysiology of this case, several reasons for thrombosis were postulated including acute organ rejection, haemostasis imbalance due to Systemic inflammation, immunosuppressive therapy. This case highlights the rarity but the significant early occurrence of STEMI in transplant recipients manifesting as changes in haemody-namic status.

Full Text, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Dept Intnl Bus&Asian Studies, Griffith Business School, BACKGROUND A growing body of literature and nearly a century of modern clinical use have established maggot therapy as an efficacious and safe wound care modality. Indeed, even before the introduction of maggot debridement therapy (MDT) to modern medicine, the wound healing properties of fly maggots were recognised by many cultures including Aboriginal Australians. This and the beneficial outcomes seen in wounded and fly-blown soldiers in past wars raises the question why MDT has not been used to treat wounds in contemporary compromised healthcare settings such as in disaster medical response, the theatre of war, or in development aid. The critical importance of supply chain management in the provision of goods and services suggests that there may be a mix of supply chain barriers that have prevented healthcare providers to offer MDT services in compromised healthcare settings. With this in mind, this study sought to answer the following research questions: 1) What is the wound burden in compromised healthcare settings; 2) is MDT a feasible therapy for wounds in compromised healthcare settings; 3) what are the characteristics of MDT supply chains in compromised healthcare settings; and 4) what are the enablers of, and barriers to, affordable, responsive, secure, sustainable, resilient and innovative MDT supply chains in contemporary compromised healthcare settings? METHODS In order to answer these research questions, a mixed methods approach was used including desktop literature reviews, optimising scenario development, and a case study with qualitative research methodology. The qualitative research was conducted with observations, a stakeholder workshop and semi-structured interviews which, in turn, were held either face-to-face, online or via email. A set of analytical tools were applied to the data, such as the rephrasing of transcripts according to the documentary method, coding of interview data, and logic model evaluation. The question as to what the burden of

Acute ST elevation myocardial infarction (STEMI) is a very rare complication post orthotopic heart transplantation. There are only limited data regarding pathophysiological mechanisms and early occurrence of STEMI in heart transplant recipients. Background(s): We describe a 45-year-old Caucasian man with severe dilated cardiomyopathy, on approximately nine months left ventricular assist device (LVAD), and a temporary right ventricular assist device (RVAD) as a bridge to cardiac transplantation. He received the organ from a 48-year-old male with no cardiac risk factors. The donor's heart had normal left ventricular (LV) ejection fraction, accordingly the presence of coronary heart disease was not tested before transplantation. The total ischaemic time was about 210 minutes. On day one post operation, he suffered left leg compartment syndrome requiring urgent fasciotomy 48 hours post-transplant, he developed a progressive reduction of cardiac output and the incremental need for inotropic support. Electrocardiogram revealed inferolateral ST elevations associated with raised troponin I (93ug/L) and echocardiogram showed severe LV dysfunction with inferolateral and inferior wall akinesia. Result(s): Percutaneous coronary intervention (PCI) and drug eluting stent insertion in the left circumflex coronary artery was successfully performed. (Fig. 1) Subsequent endomyocardial biopsy showed International Society for Heart and Lung Transplantation grade 0R and he survived after a prolonged hospital admission with minor clinical sequelae. [Figure Presented] Conclusion(s): In reviewing the pathophysiology of this case, several reasons for thrombosis were postulated including acute organ rejection, haemostasis imbalance due to Systemic inflammation, immunosuppressive therapy. This case highlights the rarity but the significant early occurrence of STEMI in transplant recipients manifesting as changes in haemody-namic status.

BACKGROUND A growing body of literature and nearly a century of modern clinical use have established maggot therapy as an efficacious and safe wound care modality. Indeed, even before the introduction of maggot debridement therapy (MDT) to modern medicine, the wound healing properties of fly maggots were recognised by many cultures including Aboriginal Australians. This and the beneficial outcomes seen in wounded and fly-blown soldiers in past wars raises the question why MDT has not been used to treat wounds in contemporary compromised healthcare settings such as in disaster medical response, the theatre of war, or in development aid. The critical importance of supply chain management in the provision of goods and services suggests that there may be a mix of supply chain barriers that have prevented healthcare providers to offer MDT services in compromised healthcare settings. With this in mind, this study sought to answer the following research questions: 1) What is the wound burden in compromised healthcare settings; 2) is MDT a feasible therapy for wounds in compromised healthcare settings; 3) what are the characteristics of MDT supply chains in compromised healthcare settings; and 4) what are the enablers of, and barriers to, affordable, responsive, secure, sustainable, resilient and innovative MDT supply chains in contemporary compromised healthcare settings? METHODS In order to answer these research questions, a mixed methods approach was used including desktop literature reviews, optimising scenario development, and a case study with qualitative research methodology. The qualitative research was conducted with observations, a stakeholder workshop and semi-structured interviews which, in turn, were held either face-to-face, online or via email. A set of analytical tools were applied to the data, such as the rephrasing of transcripts according to the documentary method, coding of interview data, and logic model evaluation. The question as to what the burden of, Thesis (PhD Doctorate), Doctor of Philosophy (PhD), Dept Intnl Bus&Asian Studies, Griffith Business School, Full Text

Compartment syndrome is a serious complication of high voltage electrical burns, limb carbonization and deep circular burns with delayed escharotomy. Without treatment, ischemic tissue damage leads to irreversible necrosis. Treatment is emergency surgical decompression. The burned patient is usually not searchable and cannot always be readily examined because of bulky dressings; diagnosis of compartment syndrome is always hard to make. The pressure transducer used in central arterial catheters is easy available. We used it to measure pressure in muscular compartments. We measured compartment pressure three times at different depths in all cases of electrical burn, carbonization and deep circumferential burns with delayed escharotomy. We also took the pressure in the uninjured limb. The pressure assessment device was composed of a blood pressure transducer commonly used in arterial catheters for arterial pressure monitoring with three connecting branches. The first branch was connected to the 'arterial pressure exit' in the monitoring device. The second, an IV tube, was connected to one litre of physiological serum in a pressure bag inflated to 200 mmHg. The third, also an IV tube with a sterile extension cable, was directly connected to an 18G standard straight needle to be inserted in the tissues for which interstitial pressure had to be measured. In patients with thermal burns, we measured pressure before and after escharotomy. Threshold intracompartmental pressure was 35 mmHg. We carried out pressure assessment of all muscular compartments during and at the end of surgery. The pressure transducer provides a pressure value in all muscular compartments with a time of installation and measuring of less than 5 minutes. Sensitivity is measured at +/- 1 mmHg. Operation is simple, non-operator dependent, and accessible to medical and paramedic teams. The pressure transducer allows accurate diagnosis of early or established compartment syndrome. It requires no additional

Objective To report morbidity and oncological outcomes in a consecutive series of lateral isolated recurrent gynecological cancer involving the pelvic side wall (PSW) including the iliopsoas muscle. Material and methods We retrospectively evaluated a consecutive series between 6/2013 and 12/2015 of lateral isolated recurrent gynecological malignancies treated with a lateral endopelvic resection (LEPR). LEPR was defined as an en-bloc lateral resection of a pelvic tumor with sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Post-surgical complications, quality of life (QoL) and survivals were computed. Results Seventy-four women with pelvic isolated relapse were admitted for surgery during the study period. Among them, 8 cases (10.8%) showed lateral isolated relapse involving the iliopsoas muscle and were treated with LEPR. R0 resection was achieved in 6/8 patients (75.0%), while the pathologic margins were microscopically and macroscopically positive in 1 patient (12.5%), respectively. There were no perioperative mortalities. Major postoperative complications occurred in 3 patients (37.5%) through peripheral neuropathies, thrombosis of the vascular graft and compartment syndrome of the leg. Median follow-up time was 21 months (range, 12–28). The 2-year overall survival (OS) was 88% improving up to 100% if R0 resection was achieved. In patients with positive pathologic margins (n = 2), the 2-year OS was 50%. All women showed an improved QoL after surgery. Conclusion LEPR with iliopsoas resection can be safely performed in selected cases with lateral isolated gynecological relapse involving the PSW and was associated with improved QoL and prolonged survival when an R0 resection was achieved.

Acute compartment syndrome (ACS) is a condition typically associated with long bone fractures or severe trauma; however, non-traumatic etiologies also occur. We describe a case of an otherwise healthy female pediatric patient presenting with unilateral forearm pain without an inciting injury. Intracompartmental pressures of the forearm were measured and she was diagnosed with idiopathic compartment syndrome. Our goal is to encourage clinicians to consider acute compartment syndrome even in the absence of trauma. [West J Emerg Med. 2015;16(1):-0.]

Introduktion: Omvårdnad är operationssjuksköterskans huvudområde. Operationssjuksköterskan ska förebygga skador och komplikationer som kan uppstå vid en operation. En sådan komplikation kan vara kompartmentsyndrom. Kompartmentsyndrom är en ovanlig komplikation men kan leda till allvarliga skador. Det är därför viktigt att operationssjuksköterskan beaktar det i sitt arbete. Syfte: Detta arbete syftar till att belysa operationssjuksköterskans erfarenheter av att arbeta med att förebygga kompartmentsyndrom i den perioperativa omvårdnaden. Metod: En kvalitativ ansats tillämpades och data samlades in via intervjuer. Insamlade data analyserades genom kvalitativ innehållsanalys. I arbetet deltog 11 operationssjuksköterskor, tio kvinnor och en man, som arbetade på fyra olika operationsavdelningar vid två olika sjukhus. Resultat: I den kvalitativa innehållsanalysen av texten framkom två kategorier, Att arbeta förebyggande samt Att handla på osäker grund. I den förstnämnda kategorin beskrevs hur operationssjuksköterskorna genomförde en individuell riskbedömning, var noggranna i positioneringen och utförde lägesändring samt massage av patientens ben för att förebygga kompartmentsyndrom. I den andra kategorin, Att handla på osäker grund, beskrevs en osäkerhet i den perioperativa omvårdnaden kring kompartmentsyndrom. Det belystes en osäkerhet runt ämnet, omvårdnadsinterventionerna ifrågasattes och en brist på vetenskaplig evidens framkom. Konklusion: Det fanns brister i riktlinjer och rutiner gällande omvårdnad kring kompartmentsyndrom. Det fanns även en brist i att implementera ny kunskap i operationssjuksköterskans omvårdnad för att kunna arbeta evidensbaserat., Introduction: Nursing is the main area for the operating room (OR) nurse. The OR nurse will prevent injuries and complications that can occur during surgery. One such complication can be compartment syndrome. Compartment syndrome is a rare complication but can lead to serious injuries. It is therefore important that the OR nurse take this in consideration in their work. Aim: This essay aims to highlight the OR nurse's experiences of working with the prevention of compartment syndrome in the perioperative nursing. Method: A qualitative approach was applied and the data were collected through interviews. Collected data were analyzed by qualitative content analysis. The essay enrolled 11 OR nurses, ten women and one man, who worked in four different surgical wards at two different hospitals. Result: After a qualitative content analysis of the data were conducted two categories emerged, Preventive work and To act on uncertain foundations. The first category described how the OR nurse undertook an individual risk assessment, was accurate in positioning and performed a change in position and massage of the patient’s leg to prevent compartment syndrome. The second category, To act on uncertain foundations, described an uncertainty in the perioperative care regarding compartment syndrome. It highlighted an uncertainty around the topic, nursing interventions were questioned and a lack of scientific evidence emerged. Conclusion: There were a lack of guidelines and recommendations regarding care about compartment syndrome. There was also a lack of implementing new knowledge in nursing to provide an evidence-based practice.

Acute compartment syndrome (ACS) is a condition typically associated with long bone fractures or severe trauma; however, non-traumatic etiologies also occur. We describe a case of an otherwise healthy female pediatric patient presenting with unilateral forearm pain without an inciting injury. Intracompartmental pressures of the forearm were measured and she was diagnosed with idiopathic compartment syndrome. Our goal is to encourage clinicians to consider acute compartment syndrome even in the absence of trauma. [West J Emerg Med. 2015;16(1):-0.]

Introduktion: Omvårdnad är operationssjuksköterskans huvudområde. Operationssjuksköterskan ska förebygga skador och komplikationer som kan uppstå vid en operation. En sådan komplikation kan vara kompartmentsyndrom. Kompartmentsyndrom är en ovanlig komplikation men kan leda till allvarliga skador. Det är därför viktigt att operationssjuksköterskan beaktar det i sitt arbete. Syfte: Detta arbete syftar till att belysa operationssjuksköterskans erfarenheter av att arbeta med att förebygga kompartmentsyndrom i den perioperativa omvårdnaden. Metod: En kvalitativ ansats tillämpades och data samlades in via intervjuer. Insamlade data analyserades genom kvalitativ innehållsanalys. I arbetet deltog 11 operationssjuksköterskor, tio kvinnor och en man, som arbetade på fyra olika operationsavdelningar vid två olika sjukhus. Resultat: I den kvalitativa innehållsanalysen av texten framkom två kategorier, Att arbeta förebyggande samt Att handla på osäker grund. I den förstnämnda kategorin beskrevs hur operationssjuksköterskorna genomförde en individuell riskbedömning, var noggranna i positioneringen och utförde lägesändring samt massage av patientens ben för att förebygga kompartmentsyndrom. I den andra kategorin, Att handla på osäker grund, beskrevs en osäkerhet i den perioperativa omvårdnaden kring kompartmentsyndrom. Det belystes en osäkerhet runt ämnet, omvårdnadsinterventionerna ifrågasattes och en brist på vetenskaplig evidens framkom. Konklusion: Det fanns brister i riktlinjer och rutiner gällande omvårdnad kring kompartmentsyndrom. Det fanns även en brist i att implementera ny kunskap i operationssjuksköterskans omvårdnad för att kunna arbeta evidensbaserat., Introduction: Nursing is the main area for the operating room (OR) nurse. The OR nurse will prevent injuries and complications that can occur during surgery. One such complication can be compartment syndrome. Compartment syndrome is a rare complication but can lead to serious injuries. It is therefore important that the OR nurse take this in consideration in their work. Aim: This essay aims to highlight the OR nurse's experiences of working with the prevention of compartment syndrome in the perioperative nursing. Method: A qualitative approach was applied and the data were collected through interviews. Collected data were analyzed by qualitative content analysis. The essay enrolled 11 OR nurses, ten women and one man, who worked in four different surgical wards at two different hospitals. Result: After a qualitative content analysis of the data were conducted two categories emerged, Preventive work and To act on uncertain foundations. The first category described how the OR nurse undertook an individual risk assessment, was accurate in positioning and performed a change in position and massage of the patient’s leg to prevent compartment syndrome. The second category, To act on uncertain foundations, described an uncertainty in the perioperative care regarding compartment syndrome. It highlighted an uncertainty around the topic, nursing interventions were questioned and a lack of scientific evidence emerged. Conclusion: There were a lack of guidelines and recommendations regarding care about compartment syndrome. There was also a lack of implementing new knowledge in nursing to provide an evidence-based practice.

El presente artículo trata sobre las compensaciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde confluyen secuelas secundarias a una fractura de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distrofia simpático refleja). El síndrome compartimental se manifiesta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracteriza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plantares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización flexora desarrollada como mecanismo de compensación digital., This article is about the compensation ortopodologicas carried out in a clinical case (man of 42 years of age) where confl Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syndrome of Sudeck (distrofi to friendly reflects). Compartment syndrome is significantly by the appearance of paleness, pain, pressure, paleness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the discolouration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning subtalar, as well as the process the clothing of the orthoses silicone to treat intense flexor stabilization mechanism developed as digital compensation.

Low flow vascular malformations include both venous and lymphatic malformations. Treatment techniques vary depending upon the type and location of the lesion. Indications for treatment include pain, neuropathy, ulceration, dysfunction and cosmesis. Many of these patients present with asymptomatic lesions that do not concern them, and once reassured that the lesion is unlikely to grow and is not a tumour, there is no indication for active treatment. Percutaneous sclerotherapy is based upon direct puncture venography, which involves placing needles percutaneously into the malformation. Access is based on ultrasound or MRI localisation from previous imaging. Once the intravascular or intralymphatic location of the needles has been confirmed, the chosen sclerosant is injected into the malformation. The volume of sclerosant injected is determined by the volume of contrast required to opacify the malformation or the lymphatic volume aspirated. There are multiple sclerosants currently available to treat these lesions. The ideal sclerosant would obliterate the malformation, be permanent, easily controllable and visible on fluoroscopy and non-toxic in the short and long term. At present this agent does not exist. Those currently in use include but are not limited to true sclerosants such as concentrated ethanol, detergent sclerosants, including sodium tetradecyl sulphate, lymphatic sclerosants and adhesive sclerosants. Complications of sclerotherapy include * Skin and local tissue necrosis * Non-target organ sclerosis * Nerve damage * Compartment syndrome * Pulmonary hypertension * Cardiovascular arrest The impact of complications is dependent on the lesion location and choice of sclerosant. A thorough understanding of the anatomical location of the lesion, particularly its deep and superficial extension is critical in minimising local complications such as nerve damage and skin necrosis. High quality pre-sclerosis imaging including MRI and ultrasound is essential. The risk

Learning Objectives 1. To learn about materials used for sclerotherapy 2. To learn the technique of sclerotherapy 3. To learn how to avoid and manage complications of sclerotherapy Low-flow vascular malformations are of two main types: venous malformations and lymphatic malformations. They are characterised by the absence of any arterial inflow, and, as their names imply, they are comprised of either abnormal venous or lymphatic channels. Clinically, they are often present at birth and grow commensurately with the child. They may occur anywhere in the body. Lymphatic malformations are subdivided into macrocystic and microcystic malformations on the basis of the size of the cysts. Most authors define macrocysts as being greater than 10 mm in diameter. Diagnosis is based on their clinical appearance and patient history. Imaging is primarily based on ultrasound and MRI. Ultrasound is used to characterise the lesions as low flow and to identify cystic spaces within the lesion. MRI allows the accurate determination of their anatomical extent. Optimal MR sequences include fat suppressed T2, STIR or PD images. Typically, venous malformations demonstrate contrast enhancement, whereas lymphatic malformations do not; however, contrast is not required for diagnosis or lesion characterisation. Angiographic imaging is not required to diagnose or treat low-flow malformations. Treatment options include surgery or interventional radiology (IR) techniques. The mainstay of IR therapy involves direct puncture sclerotherapy. Access to the lesion may be performed under ultrasound guidance; however, this may not always be feasible or necessary. The malformations are punctured using a variety of puncture needles, and intralesional location confirmed with aspiration of either blood or lymphatic fluid and injection of a contrast material. In the case of lymphatic malformations, ideally macrocystic lesions should be drained dry prior to injection of sclerosant to minimise the dilutional effe

腹腔鏡下子宮全摘術は通常、砕石位で行われる。また、深部静脈血栓症予防として弾性ストッキングあるいは間欠的空気圧迫装置が用いられる(図1) 。しかし、この体位と予防法は下腿の圧迫により稀ではあるが、下肢コンパートメント症候群を発症するリスク要因となる。今回我々は、腹腔鏡下子宮全摘術後に下肢コンパートメント症候群を発症した1 例を経験したので報告する。

To improve the diagnosis and treatment of compartment syndrome, a new non-invasive method of aeroion testing has been developed and proposed for implementation. The results of implementation of this technology on an experimental model of compartment syndrome are given in this article. Possibility of applying aeroion testing for early diagnosis on the stage of metabolic disorders onset, as well as during screening and monitoring of patients with compartment syndrome is proved., С целью усовершенствования диагностики и лечения компартмент-синдрома разработан и предложен к внедрению новый неинвазивный метод аэроионного тестирования. В статье приведены результаты апробирования этой технологии на экспериментальной модели компартмент-синдрома. Доказана возможность применения аэроионного тестирования для ранней диагностики на этапе развития метаболических нарушений, а также для скрининга и мониторинга состояния пациентов с компартмент-синдромом., З метою удосконалення діагностики і лікування компартмент-синдрому розроблено та запропоновано до впровадження новий неінвазивний метод аероіонного тестування. У статті наведено результати апробування цієї технології на експериментальній моделі компартмент-синдрому. Доведено можливість використання аероіонного тестування для ранньої діагностики на етапі розвитку метаболічних порушень, а також під час здійснення скринінгу та моніторингу стану хворих на компартмент-синдром.

El presente artículo trata sobre las compensaciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde confluyen secuelas secundarias a una fractura de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distrofia simpático refleja). El síndrome compartimental se manifiesta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracteriza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plantares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización flexora desarrollada como mecanismo de compensación digital., This article is about the compensation ortopodologicas carried out in a clinical case (man of 42 years of age) where confl Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syndrome of Sudeck (distrofi to friendly reflects). Compartment syndrome is significantly by the appearance of paleness, pain, pressure, paleness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the discolouration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning subtalar, as well as the process the clothing of the orthoses silicone to treat intense flexor stabilization mechanism developed as digital compensation.

Low flow vascular malformations include both venous and lymphatic malformations. Treatment techniques vary depending upon the type and location of the lesion. Indications for treatment include pain, neuropathy, ulceration, dysfunction and cosmesis. Many of these patients present with asymptomatic lesions that do not concern them, and once reassured that the lesion is unlikely to grow and is not a tumour, there is no indication for active treatment. Percutaneous sclerotherapy is based upon direct puncture venography, which involves placing needles percutaneously into the malformation. Access is based on ultrasound or MRI localisation from previous imaging. Once the intravascular or intralymphatic location of the needles has been confirmed, the chosen sclerosant is injected into the malformation. The volume of sclerosant injected is determined by the volume of contrast required to opacify the malformation or the lymphatic volume aspirated. There are multiple sclerosants currently available to treat these lesions. The ideal sclerosant would obliterate the malformation, be permanent, easily controllable and visible on fluoroscopy and non-toxic in the short and long term. At present this agent does not exist. Those currently in use include but are not limited to true sclerosants such as concentrated ethanol, detergent sclerosants, including sodium tetradecyl sulphate, lymphatic sclerosants and adhesive sclerosants. Complications of sclerotherapy include * Skin and local tissue necrosis * Non-target organ sclerosis * Nerve damage * Compartment syndrome * Pulmonary hypertension * Cardiovascular arrest The impact of complications is dependent on the lesion location and choice of sclerosant. A thorough understanding of the anatomical location of the lesion, particularly its deep and superficial extension is critical in minimising local complications such as nerve damage and skin necrosis. High quality pre-sclerosis imaging including MRI and ultrasound is essential. The risk

Learning Objectives 1. To learn about materials used for sclerotherapy 2. To learn the technique of sclerotherapy 3. To learn how to avoid and manage complications of sclerotherapy Low-flow vascular malformations are of two main types: venous malformations and lymphatic malformations. They are characterised by the absence of any arterial inflow, and, as their names imply, they are comprised of either abnormal venous or lymphatic channels. Clinically, they are often present at birth and grow commensurately with the child. They may occur anywhere in the body. Lymphatic malformations are subdivided into macrocystic and microcystic malformations on the basis of the size of the cysts. Most authors define macrocysts as being greater than 10 mm in diameter. Diagnosis is based on their clinical appearance and patient history. Imaging is primarily based on ultrasound and MRI. Ultrasound is used to characterise the lesions as low flow and to identify cystic spaces within the lesion. MRI allows the accurate determination of their anatomical extent. Optimal MR sequences include fat suppressed T2, STIR or PD images. Typically, venous malformations demonstrate contrast enhancement, whereas lymphatic malformations do not; however, contrast is not required for diagnosis or lesion characterisation. Angiographic imaging is not required to diagnose or treat low-flow malformations. Treatment options include surgery or interventional radiology (IR) techniques. The mainstay of IR therapy involves direct puncture sclerotherapy. Access to the lesion may be performed under ultrasound guidance; however, this may not always be feasible or necessary. The malformations are punctured using a variety of puncture needles, and intralesional location confirmed with aspiration of either blood or lymphatic fluid and injection of a contrast material. In the case of lymphatic malformations, ideally macrocystic lesions should be drained dry prior to injection of sclerosant to minimise the dilutional effe

El presente artículo trata sobre las compensaciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde confluyen secuelas secundarias a una fractura de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distrofia simpático refleja). El síndrome compartimental se manifiesta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracteriza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plantares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización flexora desarrollada como mecanismo de compensación digital., This article is about the compensation ortopodologicas carried out in a clinical case (man of 42 years of age) where confl Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syndrome of Sudeck (distrofi to friendly reflects). Compartment syndrome is significantly by the appearance of paleness, pain, pressure, paleness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the discolouration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning subtalar, as well as the process the clothing of the orthoses silicone to treat intense flexor stabilization mechanism developed as digital compensation.

El presente artículo trata sobre las compensaciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde confluyen secuelas secundarias a una fractura de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distrofia simpático refleja). El síndrome compartimental se manifiesta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracteriza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plantares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización flexora desarrollada como mecanismo de compensación digital., This article is about the compensation ortopodologicas carried out in a clinical case (man of 42 years of age) where confl Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syndrome of Sudeck (distrofi to friendly reflects). Compartment syndrome is significantly by the appearance of paleness, pain, pressure, paleness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the discolouration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning subtalar, as well as the process the clothing of the orthoses silicone to treat intense flexor stabilization mechanism developed as digital compensation.

El presente artículo trata sobre las compensaciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde confluyen secuelas secundarias a una fractura de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distrofia simpático refleja). El síndrome compartimental se manifiesta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracteriza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plantares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización flexora desarrollada como mecanismo de compensación digital., This article is about the compensation ortopodologicas carried out in a clinical case (man of 42 years of age) where confl Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syndrome of Sudeck (distrofi to friendly reflects). Compartment syndrome is significantly by the appearance of paleness, pain, pressure, paleness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the discolouration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning subtalar, as well as the process the clothing of the orthoses silicone to treat intense flexor stabilization mechanism developed as digital compensation.

Background Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated.Materials and methods A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation.Results The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error.Conclusions ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.

El presente artículo trata sobre las compen saciones ortopodológicas realizadas en un caso clínico (hombre de 42 años de edad) donde con uyen secuelas secundarias a una fractu ra de calcáneo, complicadas con un síndrome compartimental y con un síndrome de Sudeck (distroi a simpático re eja). El síndrome com partimental se manii esta mediante la aparición de palidez, dolor, presión, palidez, parálisis y/o ausencia de pulsos. El síndrome de Sudeck, por la alteración del sistema simpático, se caracte riza principalmente por el dolor, la limitación funcional y el cambio de coloración de la piel. Describimos el tratamiento ortopodológico instaurado en el caso, mediante soportes plan tares termoconformados con objeto de dotar mayor estabilidad y amortiguación subtalar, así como el proceso el confección de la ortesis de silicona para tratar la intensa estabilización exora desarrollada como mecanismo de com pensación digital., This article is about the compensation orto podologicas carried out in a clinical case (man of 42 years of age) where con Uyen secondary sequelae to a calcaneus fracture, complicated with a compartment syndrome and with a syn drome of Sudeck (distroi to friendly re ects). Compartment syndrome is signii cantly by the appearance of paleness, pain, pressure, pale ness, paralysis and/or absence of pulses. The syndrome of Sudeck, by an alteration of the sympathetic system, it is mainly characterized by pain, functional limitations and the disco louration of the skin. We describe the treatment ortopodologico established in the case, using brackets thermoconformed plantar in order to provide greater stability and cushioning sub talar, as well as the process the clothing of the orthoses silicone to treat intense exor stabili zation mechanism developed as digital compen sation.

BACKGROUND: In 2008, we showed that incomplete or delayed extremity fasciotomies were associated with mortality and muscle necrosis in war casualties with limb injury. Subsequently, we developed an education program focused on surgeon knowledge gaps regarding the diagnosis of compartment syndrome and prophylactic fasciotomy. The program included educational alerts, classroom training, video instruction, and a research publication. We compared casualty data before and after the program implementation to determine whether the education altered outcomes. METHODS: Similar to the previous study, a case series was made from combat casualty medical records. Casualties were US military servicemen with fasciotomies performed in Iraq, Afghanistan, or Germany between two periods (periods 1 and 2). RESULTS: In both periods, casualty demographics were similar. Most fasciotomies were performed to the lower leg and forearm. Period 1 had 336 casualties with 643 fasciotomies, whereas Period 2 had 268 casualties with 1,221 fasciotomies (1.9 vs. 4.6 fasciotomies per casualty, respectively; p G 0.0001). The mortality rate decreased in Period 2 (3%, 8 of 268 casualties) from Period 1 (8%, 26 of 336 casualties; p = 0.0125). Muscle excision and major amputation rates were similar in both periods (p 9 0.05). Rates of casualties with revision fasciotomy decreased to 8% in Period 2, (22 of 268 casualties) versus 15% in Period 1 (51 of 336 casualties; p = 0.009). CONCLUSION: Combat casualty care following implementation of a fasciotomy education program was associated with improved survival, higher fasciotomy rates, and fewer revisions. Because delayed fasciotomy rates were unchanged, further effort to educate providers may be indicated., Published in the Journal of Trauma and Acute Care Surgery, v74 n1 p259-263, 2013.

[West J Emerg Med. 2013;14(5):431–434.]

[West J Emerg Med. 2013;14(5):431–434.]