Page 84 - 2022 Spring JSOM

Methods FIGURE 1 Anterior and lateral compartment release using rescue
hook.
Fresh, never-frozen, non-embalmed cadavers aged 18 years or
older at the time of death were obtained through the Cen-
tre for Emergency Health Sciences, Spring Branch, TX. We
excluded cadavers with below-knee amputation (forefoot,
Symes, and digital amputations were acceptable), medial or
lateral leg scars consistent with orthopedic plating, and prior
fasciotomy or plastics reconstruction. Isolated medial leg scars
in the presence of a median sternotomy scar (consistent with
saphenous vein harvesting for coronary bypass grafting) were
acceptable. Cadavers used for other research or training pur-
poses were acceptable as long as at least one leg was available
for the procedure. The age at death and presumptive cause of
death were collected for each cadaver.
(A)
FIGURE 2 Alternative devices used
The fasciotomies were performed by a trauma surgeon using for performance of four-compartment
a two-incision, four-compartment technique. Two longitudi- leg fasciotomy. (B)
7
nal incisions were made on the medial and lateral aspects of (A) Curved Mayo scissors.
the leg, and these were taken down through the yellow sub- (B) Leatherman Raptor multitool. (C)
cutaneous fat until the white muscular fascia was identified. (C) Benchmade Model 5 Hook.
On the lateral aspect, the intramuscular septum was identified (D) Leatherman Z-Rex multitool. (D)
by making a transverse incision in the fascia over the palpa- (E) No. 10 PenBlade.
ble band that divides the anterior and lateral compartments (E)
(Figure 1). The compartments were then incised cephalad and
caudad to the knee and ankle, respectively. The medial fasci-
otomy was performed by incising the muscular fascia overly- surgeon. The following device characteristics were recorded
ing the superficial posterior compartment in a similar fashion, for comparison: length, width, and weight. For the hook-type
followed by incision of the fascial attachment to the tibia, devices, we also measured the angle of the hook in relation to
accessing the deep posterior compartment. A disposable No. the long axis of the body of the device.
10 blade scalpel was used to incise the skin and subcutane-
ous tissues and to make the initial incisions on the fascia. The This study received a nonhuman subject research waiver from
opening of each fascial compartment was then completed with the University of Texas Health San Antonio Institutional Re-
one of the following five instruments: 5.5-in curved Mayo scis- view Board (protocol number, HSC20200936N) and was
sors; Benchmade 5 hook (model BM-5BLKW); rescue hook on performed under the Centre for Emergency Health Sciences
the Leatherman Raptor multitool (model 831741-FFP); Leath- procedural training protocol, meeting the Anatomical Board
erman Z-Rex multitool (model LM93408); No. 10 PenBlade of the State of Texas regulations. This manuscript received
(model PB-M-10-CAS) (Table 1 and Figure 2). authorization for publication from the Brooke Army Medical
Center Public Affairs office.
After fasciotomy, each cadaver was inspected for release of
all four compartments (anterior, lateral, superficial posterior,
deep posterior) from 5 cm distal to the fibular head to 5 cm Results
proximal to the lateral malleolus, and from 5 cm distal to the A total of six complete four-compartment fasciotomies were
medial tibial condyle and 5 cm proximal to the medial malle- performed on three male cadavers aged 71, 80, and 90 years.
olus. We recorded the length of the skin and fascial incisions, Reported cause of death for each was cardiac arrest, cerebro-
allowing for calculation of a skin-incision–to–fascia-incision vascular accident, and pancreatic cancer, respectively. These
ratio. Additionally, we performed dissection to identify any in- cadavers all were well developed and had been previously used
jury to the GSV or to the superficial peroneal nerve. A subjec- in a procedural training program. Each specimen had the GSV
tive critique of each technique was completed by the operating cutdown performed anterior to the medial malleolus. These

TABLE 1 Specifications of Alternative Equipment Examined for Performance of Austere Fasciotomy
Manufacturer Length Weight Tip Width Hook Angle
Commercial Name Part No. NSN Description (cm) (g) (cm) (degrees)
Millennium surgical 5.5" 1-008 6515-01-506-0268* Scissors, general surgical 14 46 0.4 NA
curved Mayo scissors
Benchmade No. 5 Hook 5BLKW Unavailable** Hook knife, rescue 7.5 29 0.6 40
Leatherman Raptor 831741-FFP 5110-01-627-1451 Multi-tool, folding, pocket 16,12.8*** 160 0.2 35
Leatherman Z-Rex LM93408 Unavailable Unavailable 17 43 0.2 25
No. 10 PenBlade PB-M-10-CAS 6685-01-341-6140 Blade, pen 15.2 11 0.9 NA
*NSN for generic 5.5" curved Mayo scissors, not specific to the instrument tested.
**Alternative item with similar specifications (not tested): Benchmade Model 7 Hook (7BLKW); NSN 4240-01-543-9618 (hook knife, rescue);
length, 15.2 cm; weight, 43 g; hook width, 0.6 cm; hook angle, 40 degrees.
***Open, closed length, respectively.
NA, not applicable; NSN, National Stock No.

82 | JSOM Volume 22, Edition 1 / Sping 2022