Nephrol Dial Transplant (2003) 18: 1416
© 2003 European Renal Association-European Dialysis and Transplant Association
Letters and Replies
Does fasciotomy hurt the patients with crush syndrome?
Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan. Email: ymlin{at}vghtc.gov.tw
Sir,
I read with interest the well-written article in the November 2002 issue entitled ‘Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake’ by Sever et al. [1]. The reported findings support the attitude not to undertake fasciotomy unless clear objective indications are present such as increased intracompartmental pressure. Fasciotomies were found to be a significant risk factor for sepsis, and sepsis in turn was associated with mortality [1]. However, there is a paucity of reports concerning intracompartmental pressure measurement in crush syndrome patients, especially in mass casualties, and a need for prospective studies of the intracompartmental pressure in such patients [2]. Could the authors provide some details of intracompartmental pressure measurement in their patients?
Though fasciotomy is a valid surgical indication in patients with crush syndrome [3], Matsuoka et al. provided no evidence that fasciotomy improves outcome in patients with crush syndrome [4]. Huang et al. also reported a high infection and amputation rate in their series [2]. Fasciotomy should be withheld in patients with crush syndrome because of the frequent delay in rescue in major earthquakes, unless there is an overriding reason for it [5].
Conflict of interest statement. None declared.
References
- Sever MS, Erek E, Vanholder R et al. Clinical findings in the renal victims of a catastrophic disaster: The Marmara earthquake. Nephrol Dial Transplant 2002; 17:1942–1949
[Abstract/Free Full Text] - Huang KC, Lee TS, Lin YM, Shu KH. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc 2002; 101:249–256[Medline]
- Pellegrini VD Jr, Reid S, Evarts CM. Complications. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Roock and Green's Fractures in Adults. 4th edn. vol 1. Philadelphia, Lippincott–Raven Publishers, 1996;449–451
- Matsuoka T, Yoshioka T, Tanaka H et al. Long-term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: Prognostic indicators in retrospect. J Trauma 2002; 52:33–39[Medline]
- Better OS, Stein JH. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990; 322:825–829[Web of Science][Medline]
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