Reperfusion injuries and compartment syndrome

Having spent 6 hours in theatre yesterday assisting with re-perfusing an acutely ischaemic leg in a patient with multiple previous vascular surgical history, today was a pretty busy day managing the post-operative complications that can arise due to reperfusion of the muscles. Serious complications of re-perfusion includes hyperkalaemia (release of potassium from dead/necrotic muscles), renal failure secondary to release of creatinine kinase into the circulation (again from ischaemic muscles) which is nephrotoxic, and compartment syndrome.

Having had no blood supply to the leg for few hours, the reperfusion of the muscles of the lower limb can lead to tissue/muscle oedema secondary to release of inflammatory mediators from damaged tissues. This initially leads to compromised venous return and therefore leads to venous congestion. This leads to further increase in the intra-compartmental pressures, and a vicious circle is set up. If the intra-compartmental pressure exceeds the perfusion pressure; this can lead to irreversible ischaemic damage to the muscles. If compartment syndrome develops, urgent release of the compartment pressure by a fasciotomy is required to prevent irreversible ischaemic damage to the muscle groups.

For further details on re-perfusion injuries and compartment syndrome; visit our website www.iwanttobeasurgeon.com (Website currently under construction)

Remember; If a patient has pain out of proportion to the injury sustained; suspect compartment syndrome, and early recognition and action can help save the limb.

Romesh

First update

Seems like Amel has been pretty busy over the last few days blogging. Congratulations to Amel and Tarik for their poster presentation, no doubt it wil tick all the right boxes when it comes to Core surgical training application.

In my end, i have been relatively busy with my vascular job, which i am thoroughly enjoying. I had very little exposure tovascular surgery as a student, however this job has opened  my eyes to the joys of vascular surgery, in particular the wide range of extraordinary surgeries that are being performed everyday such as visceral hybrid repairs, arch hybrid repair, type 1-4 thoracoabdominal aneurysm repairs, carotid endarterectomies, carotid-carotid bypass etc. I shall blog about these interesting procedures in the near future.

In addition to the free MRCS advice given by Amel, i just would like to add a few more tips.

 Consider tutoring groups of medical students, this will help refresh examination skillls, as well as help you to examine a wide variety of patients who you may not see otherwise. For example: being a vascular house officer, i am only exposed to vascular patients, this means that for the next few months i will not see/examine many general surgical patients. By tutoring a group of final year students, in addition to learning vascular surgery, i will be exposed to general surgical, and orthopaedic patients. This will no doubt be invaluable when i prepare for the MRCS Part B. In addition, the students can also fill out feedback form for the teaching you provide, which wil of couse tick the 'teaching experience' part of your job application form/interview.

So keep tuned for blogs on further MRCS advice, tips, hints, as well as posts on current vascular surgical procedures.

Romesh