SLR - April 2022 - Alexandra Heidtmann
Reference: Schupbach DE, Nasser Eddine M, Honjol Y, Merle G, Harvey EJ. Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model. JBJS Open Access. 2021 Nov 23;6(4):e21.00040. doi: 10.2106/JBJS.OA.21.00040. PMID: 34841190; PMCID: PMC8613368.Level of Evidence: IV
Scientific Literature Review
Reviewed By: Alexandra Heidtmann, DPM
Residency Program: Highlands-Presbyterian/St Luke’s – Denver, CO
Podiatric Relevance: Acute compartment syndrome is an urgent and difficult condition to treat. Currently, there is no reliable method to treat foot compartment syndrome. In addition, current treatments often lead to complications including neurologic deficits, claw toes, amputations, and skin-healing problems. The primary aim to the study was to evaluate the use of new modeling, measuring and treatment techniques. The secondary aim was to define discrete foot compartments for release and to validate a modified minimally invasive release with the use of indwelling continuous pressure sensors.
Methods: The study included eight fresh-frozen lower extremity specimens, excluding any systemic disease or surgical scars that could suggest compromised anatomy. Utilizing pressure-controlled saline infusion to induce pressure, the specimens were submitted to continuous pressure to simulate compartment syndrome in human cadaveric feet. The model additionally contained a multi-compartment pressure monitoring set up. A novel technique of releasing all compartments of the forefoot percutaneously was then performed. This technique consists of two 1cm incision on the dorsum of the foot: one medial incision between the proximal first and second metatarsals; and one lateral incision between the proximal fourth and fifth metatarsals. Each incision centered 4cm proximal to its respective webspace. Once the dissection was carried down to bone, the interosseous fascia was opened longitudinally, and the interosseous muscle was separated away from the bone. Medially, the adductor compartment was encountered as a fascial compartment just past the muscle slips. Laterally, blunt dissection was used to release the central and lateral compartments.
Results: Pressure increased in all four compartments above 30mmHg during preparation, and it returned to baseline after percutaneous release. The average pressure decrease was 34.6 mmHg, which was significant (p < 0.05). The average post-fasciotomy pressure was 9.5 mmHg. Following release, all specimens were surgically dissected to examine for any soft tissue damage. Examination did not reveal any injuries to cutaneous nerve branches, extensor tendons, or dorsalis pedis artery.
Conclusions: Despite the small sample size and cadaveric nature of the study, this novel percutaneous technique successfully released pressure within all compartments of the forefoot without any soft tissue injury. The ease and reproducibility of the technique also play a crucial role in the context of acute compartment syndrome, given the urgent scenario and need for immediate intervention. This study has potential to serve as a foundation to guide clinical studies to improve management of acute compartment syndrome.