The need to relieve muscle swelling and secondary vascular impairment of an extremity may occur following a variety of conditions. Regardless of the type of insult, massive swelling of an extremity can result in ischemic necrosis of muscle as a result of tamponade produced by restrictive circulferential fascia. When intracompartmental pressure approaches or exceeds arterial pressure, a portion or the entire extremity may be in jeopardy. Fasciotomy is one of the most important adjunctive procedures available to assure survival of an extremity with altered distal circulation resulting from massive swelling. Its importance has been stressed infrequently in the literature. The indications for its use are outlined in a variety of clinical situations. The proper techniques have few complications and much to offer with regard to limb salvage and reduction of morbidity. Fasciotomy does not preclude correction of the underlying cause for restrictive muscle tamponade when possible, nor can it be expected to reverse well established ischemia. Early and liberal use of fasciotomy is advocated when the outlined indications prevail.

Anterior Compartment Syndrome↗

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Acute arterial occlusions.

We believe that streptokinase is safe and effective in restoring the patency of arteries that have been acutely occluded by thrombosis or embolization. It should be used on those patients in whom the branches as well as the main conduits are occluded. It should also be used when the risks of surgery are great because of concurrent medical problems. Streptokinase should not be used after major surgery, in patients with blood dyscrasias, or when there are neurologic deficits secondary to the arterial ischemia. Streptokinase should not be considered as an antagonist to arterial surgery with the use of the Fogarty catheter but as an adjunct to the ever increasing armamentarium of the vascular surgeon.

Acute Disease↗

PubMedDate not supplied

Ruptured abdominal aortic aneurysms with aorto-caval fistula.

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Aged↗