Establishment of a Clinically Relevant Blunt Injury Swine Animal Model for Extremity Compartment Syndrome in the Adult Swine (Sus scrofa).

摘要

This document is the Final Report of the Establishment of a Clinically Relevant Blunt Injury Swine Model for Extremity Compartment Syndrome project funded by AFMSAISG9S contract AFDW-2011-00ZA, This Final Report discusses the successful completion of the program objectives. Extremity injuries are the most common injury reported from the current conflicts in Iraq and Afghanistan. Between January of 2005 and August of 2006 Ritenour, et al reported seventy-three patients required 177 fasciotomies with 85% carrying the diagnosis of Extremity Compartment Syndrome (ECS) in Germany after transport. ECS is the result of an increase in intramuscular pressure (IMP) due to an increase in intramuscular fluid, either due to edema or hemorrhage. As fluid increases the pressure within the compartment that contains the muscle(s) increases. As this occurs IMP may exceed myoneural capillary perfusion pressure, severely limiting or halting blood flow, resulting in tissue ischemia. Pearse et al defined acute compartment syndrome as 'a surgical emergency characterized by raised pressure in an unyielding osteofascial compartment' that can be caused by trauma, revascularization procedures, or exercise. While the exact IMP at which acute compartment syndrome occurs is debated, it is generally accepted that it occurs when the IMP increases to within 30 mm Hg of mean arterial pressure (MAP). The relationship between blood pressure and IMP is critical in the case of battlefield trauma in which blood pressure is often lowered due to hemorrhage, i.e., compartment syndrome occurs at a lower IMP in a hypotensive patient.