Kompartman Sendromunda Acil Fasyotomi İlkeleri
Özet
Kompartman sendromu, fasyal kompartmanlarda basınç artışına bağlı doku perfüzyon bozukluğuyla karakterize, geri dönüşümsüz kas-sinir hasarına ve ekstremite kaybına yol açabilen tıbbi bir acildir. Tanı klinik şüphe (özellikle orantısız ağrı, parestezi, 6P bulguları) ve kompartman içi basınç (KİB) ölçümü (ΔP = Diyastolik KB - KİB <30 mmHg veya mutlak KİB >30-45 mmHg) ile konur. Kesin tedavi, semptom başlangıcından sonraki ilk 6-12 saat içinde uygulanan acil fasyotomidir. Bu işlem, etkilenen kompartmanların deri ve fasyasının uzunlamasına insizyonu ile gerçekleştirilir (bacakta lateral/medial insizyon, önkolda dorsal/volar insizyon gibi spesifik teknikler kullanılır). Yetersiz veya gecikmiş dekompresyon, rabdomiyoliz, böbrek yetmezliği, kontraktür ve amputasyon gibi ciddi komplikasyonlara yol açar. Fasyotomi sonrası yara açık bırakılır, enfeksiyon izlenir, nekrotik doku debridmanı yapılır ve sekonder kapama veya greftleme planlanır. Erken tanı ve zamanında fasyotomi hayat ve uzuv kurtarıcıdır.
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