Whitesides describes a bedside technique using a syringe, stopcock, saline tubing, and mercury manometer to directly measure tissue pressure within closed compartments. The paper asks whether objective pressure measurement can replace unreliable clinical signs in guiding the fasciotomy decision. Four case reports illustrate the technique in patients where clinical signs were inconclusive, unevaluable, or misleading.
The classic teaching that absent pulses or motor deficit should trigger fasciotomy is wrong — and this paper is the reason we abandoned it. By the time those findings appear, ischemia is established and full recovery is unlikely (13% complete recovery with foot drop at diagnosis).
The operative principle is the delta pressure. When you measure a compartment, always compare it to the patient's diastolic BP, not an absolute cutoff. In a normotensive patient, act at 40–45 mm Hg with any symptoms. In a hypotensive trauma patient, that threshold is lower. Their arteriolar perfusion pressure is already reduced.
When compartment pressure equals diastolic BP, fasciotomy is non-negotiable regardless of pulse exam. The Whitesides technique gives you an objective number at the bedside with equipment available in any ward or emergency bay.
This paper directly anchored the delta-pressure threshold of ≤30 mm Hg that appears in current trauma guidelines, and established the conceptual framework that Mubarak, Hargens, and Matsen later refined with continuous catheter monitoring.
Whitesides describes a bedside technique using a syringe, stopcock, saline tubing, and mercury manometer to directly measure tissue pressure within closed compartments. The paper asks whether objective pressure measurement can replace unreliable clinical signs in guiding the fasciotomy decision. Four case reports illustrate the technique in patients where clinical signs were inconclusive, unevaluable, or misleading.
The classic teaching that absent pulses or motor deficit should trigger fasciotomy is wrong — and this paper is the reason we abandoned it. By the time those findings appear, ischemia is established and full recovery is unlikely (13% complete recovery with foot drop at diagnosis).
The operative principle is the delta pressure. When you measure a compartment, always compare it to the patient's diastolic BP, not an absolute cutoff. In a normotensive patient, act at 40–45 mm Hg with any symptoms. In a hypotensive trauma patient, that threshold is lower. Their arteriolar perfusion pressure is already reduced.
When compartment pressure equals diastolic BP, fasciotomy is non-negotiable regardless of pulse exam. The Whitesides technique gives you an objective number at the bedside with equipment available in any ward or emergency bay.
This paper directly anchored the delta-pressure threshold of ≤30 mm Hg that appears in current trauma guidelines, and established the conceptual framework that Mubarak, Hargens, and Matsen later refined with continuous catheter monitoring.