MCACS - In Acute Peripheral Compartment Syndrome, Changes in Biomarkers of Injury in the Intramuscular Compartment are Similar to those in the Overlying Subcutaneous Tissue: a Preclinical Swine Model

Back to 2024 Abstracts

In Acute Peripheral Compartment Syndrome, Changes in Biomarkers of Injury in the Intramuscular Compartment are Similar to those in the Overlying Subcutaneous Tissue: a Preclinical Swine Model
Maria Bejar-Chapa, MD; Mitchell Kennedy B.S.; Daniah ALNafisee, MD, B.S.; Hiroshi Fujimaki, MD, Ph.D.; Jenna Lambert B.S.; Jaeyoung Lee B.S.; Katharine P Playter B.S.; Aviv Liani B.S.; Giorgio Giatsidis, M.D, Ph.D.
Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA, 01655, USA.

Background: Peripheral compartment syndrome (PCS) affects 8/100,000 people/year and has a 15-20% mortality rate following emergent fasciotomy. Currently, diagnosis is based either on clinical evaluation, which can miss up to 30% of cases due to inconsistent symptoms, or on intra-compartmental pressure (ICP) measurements, which are inaccurate, invasive, and operator-dependent. Minimally-invasive sampling of biomarkers of injury (pH, glucose, and lactate) in interstitial fluid (ISF) by microdialysis could provide an adjunct alternative tool to support diagnosis; this technique has shown to effectively detect flap ischemia 1-2 hours before clinically apparent. Given the shared vascularity between a muscle compartment (IM) and its overlying subcutaneous tissue (SCT), we hypothesized that biomarkers of injury in both locations are similar in cases of PCS.
Methods: Yorkshire male swine (40-50kg, n=4) were used in a PCS model through bilateral hind-limb tourniquet inflation. The peroneous tertius muscle was monitored with a microdialysis probe for changes in biomarkers of injury (pH, glucose, lactate) over 6-hours. Microdialysates were compared between the SCT overlying the compartment and the IM.
Results: There were no statistically significant differences in pH (SC: 7.1�0.3, IM: 6.8�0.5; p=0.08), glucose (SC: 1.5�2.1 mg/dL, IM: 1.9�2.4 mg/dL; p=0.65), or lactate (SC: 9.9�6.1 mg/dL, IM: 10.3�4.6 mg/dL; p=0.86) levels between SCT and IM microdialysates over 6-hours.
Conclusion: Microdialysis of SCT monitors biomarkers of injury, similar to IM measurements. Continuous monitoring of these biomarkers may improve accuracy in the diagnosis of PCS. Further translational and clinical research will need to validate the accuracy and safety of microdialysis-based diagnosis of PCS.

Back to 2024 Abstracts