Nephrol Dial Transplant (2003) 18: 1416-1417
© 2003 European Renal Association-European Dialysis and Transplant Association
Letters and Replies
Reply
1 Istanbul School of Medicine 2 Cerrahpasa Scholl of Medicine, Istanbul, Turkey 3 University Hospital Ghent, Belgium 4 Marmara School of Medicine 5 Uludag School of Medicine, Bursa 6 Goztepe Social Security Hospital, Istanbul 7 Haydarpasa Numune Hospital, Istanbul 8 Gulhane Military School of Medicine, Ankara, Turkey 9 Renal Division , CH Angrignon, Montreal, Canada
Sir,
We thank Dr Lin for his interest in our article. We would like to point out that in the article, we stressed that in our series, fasciotomies were performed as a routine procedure for the treatment of compartmental syndrome, and in none of the patients were intracompartmental pressures measured [1]. We therefore (unfortunately) cannot provide any intracompartmental pressure measurements for the present series. Also, in the paper we suggested that the practice followed by our medical community during this disaster was not correct, and our findings (that fasciotomies are potential sources of wound infections that can result in sepsis and even death) contradicted earlier suggestions in favour of early fasciotomies [2,3].
Actually, fasciotomies carry an even higher risk of infection in disaster conditions, since heavy patient overload and the chaos of the situation can result in improper wound care. Thus, one should be even more cautious about the indications for fasciotomies in disaster victims as compared with cases in routine clinical practice.
In their well-written paper, Oda et al. [4] reported that only in some of the Kobe disaster victims were intracompartmental pressures measured; also in their series, most cases were fasciotomized without objective criteria. Thus, we are not aware of any reports providing information on intracompartmental pressures of compartmental syndromes in disaster victims.
We would like to draw attention once more to mannitol (which is frequently administered for the prophylaxis of acute renal failure in crush victims), and can also be beneficial for the treatment of compartmental syndrome [5,6]. Thus, we emphasize the importance of a conservative approach in the treatment of crush victims' compartmental syndromes. To perform surgical fasciotomies only with clear indications can decrease the number of wound infections and sepsis, hence resulting in an improved prognosis in this patient population.
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] - Sherg ZY. Medical support in Tangshan earthquake: a review of the management of mass casualties and certain major injuries. J Trauma 1987; 27:1130–1136[Web of Science][Medline]
- Shaw AD, Sjolin SU, McQueen MM. Crush syndrome following unconsciousness. Need for urgent orthopaedic referral. BMJ 1994; 309:857–859
[Free Full Text] - Oda J, Tanaka H, Yoshioka T et al. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma 1997; 42:470–476[Web of Science][Medline]
- Better OS, Rubinstein I, Winaver JM, Knochel JP. Mannitol therapy revisited (1940–1997). Kidney Int 1997; 52:886–894[Web of Science][Medline]
- Daniels M, Reichman J, Brezis M. Mannitol treatment for acute compartmental syndrome. Nephron 1998; 79:492–493[Medline]
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