Subcutaneous depth in a traumatized lower extremity

Mellisa Roskosky, Gillian Robinson, William Reisman, Bruce Ziran, Michael S. Shuler, Brett Freedman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Acute compartment syndrome is a rare but serious consequence of traumatic leg injury. Near-infrared spectroscopy (NIRS) is able to measure oxygenation to a depth of 2 cm to 3 cm below the skin, raising concerns over the ability of NIRS to accurately determine oxygenation of injured leg compartments in the presence of swelling and in the obese. The purpose of this study was to measure the thickness of the subcutaneous tissue overlying the posterior muscle compartment in subjects with tibia fractures to determine if it might compromise rSO2 measurement in the muscle. METHODS: Data were analyzed on 50 patients with severe leg injuries. Distance from the skin to the fascia in the superficial posterior compartment of both legs was measured on each patient using a portable ultrasound device. RESULTS: Subject age ranged from 18 years to 65 years (mean, 39 years), with 43 male and 7 female patients. The mean (SD) subcutaneous adipose tissue thickness (ATT) was 6.98 (3.17) mm for the injured leg and 7.06 (3.37) mm for the uninjured leg, and the mean body mass index for the group was 27.08 kg/m. No significant correlation was found between the ATT of the injured or uninjured legs and body mass index. Mean comparison testing revealed no difference in ATT between the injured and uninjured legs (null hypothesis: equal means, p > 0.05). Of the 50 subjects analyzed, no subject had a subcutaneous depth of more than 2 cm on the injured or uninjured leg. CONCLUSION: These data suggest that, within this traumatically injured population, symptoms associated with leg injury (such as swelling and edema) do not significantly affect the distance from the skin to the fascia. It is also notable that subcutaneous depth beyond the 2-cm mark (validated in previous studies) is a rare occurrence in this population. These results further support the use of continuous NIRS monitoring for diagnosis of acute compartment syndrome. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)S190-S193
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number3 SUPPL. 2
DOIs
StatePublished - Jan 1 2014

Keywords

  • Near-infrared spectroscopy
  • acute compartment syndrome
  • diagnostic test
  • monitoring
  • subcutaneous

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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