Early Fasciotomy and Limb Salvage and Complications in Military Lower Extremity Vascular Injury.

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Abstract

[Indexed for MEDLINE] 18. Am J Emerg Med. 2023 Aug;70:140-143. doi: 10.1016/j.ajem.2023.05.037. Epub 2023 Jun 1. Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome. Scoville NM(1), Ding L(2), Stacey AW(2). Author information: (1)Department of Ophthalmology, University of Washington, 908 Jefferson St Building, 7th Floor, Seattle, WA 98104, United States of America. Electronic address: Nicholas.scoville@osumc.edu. (2)Department of Ophthalmology, University of Washington, 908 Jefferson St Building, 7th Floor, Seattle, WA 98104, United States of America. PURPOSE: Vision loss after facial trauma can occur from orbital compartment syndrome (OCS). Orbital compartment syndrome is commonly treated surgically with a lateral canthotomy and cantholysis (C&C). Our study investigates success rates of lateral C&C for the treatment of OCS amongst emergency medicine (EM) and ophthalmology providers. METHODS: A retrospective cohort study was performed. Cases were identified and the electronic medical record of patients was interrogated for clinical and procedural information. Success of a lateral C&C was defined as a decrease in intraocular pressure (IOP) to 30 mmHg and a post-procedure IOP measurement; or alternatively if no pre-procedure IOP was documented but the IOP was >30 on arrival to the level 1 trauma center. Exclusion criteria included periprocedural use of ocular hypotensive medications and comorbid hyphema. RESULTS: The final analysis included 74 eyes from 64 patients. Emergency medicine providers performed the initial lateral C&C in 68% of cases compared to 32% by ophthalmologists, and success rates were comparable - 68% vs 79.2%, respectively (p = 0.413). Poorer visual outcomes were associated with the initial failure of a lateral C&C and head trauma without an orbital fracture. All patients treated with a vertical lid split procedure met the criteria for 'success' as defined by this study. CONCLUSIONS: The success rate of a lateral C&C is comparable amongst EM and ophthalmology providers. Improved training of physicians on the lateral C&C or other simpler procedures, such as the vertical lid split, could improve outcomes in OCS. Copyright © 2023 Elsevier Inc. All rights reserved. DOI: 10.1016/j.ajem.2023.05.037