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tube during the Tactical Field Care and Enroute Care phases for performing field fasciotomies should review their available
of Tactical Combat Casualty Care. Risk of infection in this equipment and consider incorporating these alternative de-
setting is best mitigated by peri-procedural antibiotics, skin vices into a cadaver-based procedural training program.
preparation (i.e., Betadine), decontamination of instruments,
and post-procedural coverage of the sites with sterile dressings. Acknowledgments
The authors would like to acknowledge the men and women
Future Directions
Selective fasciotomy has been proffered to minimize mor- who donate their remains to support medical research and
bidity associated with fasciotomy incisions. In a study of 51 procedural development. Without their precious gift, untimely
patients with leg ACS, 80% were managed with selective de- death and needless suffering would prevail. We would also like
compression of only compartments with elevated compart- to thank the University of Texas Southwestern Medical Cen-
mental pressures. The authors reported only one patient taken ter Willed Body Program and staff for their tireless efforts to
back for additional compartment release and noted that every enhance the medical arts beyond walls and borders. We would
patient required anterior compartment release and that two- additionally like to extend our gratitude to Centre Labora-
compartment release was adequate in 67% of patients. Al- tory Director Jennifer Achay and Lab Technician Jenna Dixon
27
though these data are intriguing, they will not be applicable to for their work enabling this study. Lastly, we would like to
field fasciotomy until individual compartment pressures can gratefully acknowledge David Baker for his continued work
be measured reliably, which may be possible with increased clarifying medicine with illustrative excellence.
experience and training using either the C2Dx, Compass, or
other pressure transducers. Author Contributions
ED and CH conceived of the manuscript concept. ED per-
Limitations formed research. ED, CH, and SB performed data collection.
This was a proof-of-concept study to evaluate the perfor- ED and CH drafted the manuscript. All authors were involved
mance of field fasciotomy with alternative instruments. The in revisions and approved the final manuscript.
fresh cadaver models used had appropriate anatomy for the
fasciotomies performed; however, none of the models had Disclaimer
tense compartments consistent with ACS. It is our opinion The view(s) expressed herein are those of the author(s) and do
that the bulging compartments seen in ACS make the proce- not reflect the official policy or position of Brooke Army Med-
dure easier and provide visual evidence that decompression ical Center, the U.S. Army Medical Department, the U.S. Army
has been accomplished. It may be possible to simulate elevated Office of the Surgeon General, the Department of the Army,
compartment pressure in this cadaver model, thereby adding the Department of the Air Force and Department of Defense,
additional realism to procedural training and allowing for or the U.S. Government.
simulated compartment pressure monitoring. We cannot draw
conclusions from the single superficial peroneal nerve injury Financial Disclosures
because this proof-of-concept study was not adequately pow- The authors have no relevant financial relationships to disclose.
ered to compare the techniques. A surgeon performed the fas-
ciotomies, so we cannot speculate on how the devices would References
perform in the hands of medics. However, these data and sub- 1. Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC. Char-
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(Suppl 1):S22–S25.
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with the FDA (registration number 3010780223) with indi- cal Practice Guideline (JTS CPG): Crush Syndrome - Prolonged
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use of the PenBlade in a retracted configuration for this study jts.amedd.army.mil/assets/docs/cpgs/Crush_Syndrome_PFC_28_
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Medical Sergeant Skill Levels 3 and 4. October 2003. https://
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-hour-last/. Accessed 26 March 2021.
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