Background:
Acute limb compartment syndrome is a potentially devastating complication of musculoskeletal trauma characterized by an increase in pressure within a closed osseofascial compartment resulting in muscle threatening and ultimately limb threatening ischemia. Pressure within a compartment rises to such a degree that tissue perfusion becomes comprised reducing microcirculatory perfusion restricting oxygen and vital nutrients to tissues ultimately leading to cellular anoxia and severe tissue necrosis. Fasciotomy, a surgical procedure where the fascia is cut to relieve pressure and decompress all the muscles in the involved compartments remains the only effective treatment and current gold standard surgical therapy. Although the procedure has a high success rate to relieve pressure and prevent limb loss, it is not without complications that can include accidental damage to a nearby nerve, infection and severe scarring. There is a need for new treatments.
Description of the Invention:
Our researchers have developed a unique laboratory model of compartment syndrome to further elucidate the mechanisms of tissue damage in compartment syndrome demonstrating a damaging pro-inflammatory component. Further, they have demonstrated that carbon monoxide (CO), a by-product of heme oxygenase activity, offers both protection to microvascular perfusion and anti-inflammatory benefits during compartment syndrome. Although exogenous delivery of CO via inhalation has previously been shown to be beneficial during systemic inflammatory response syndrome, such method of administration results in increased carboxyhemoglobin levels presenting a potential threat to the host. Our results demonstrate that local delivery of CO to limbs subjected to acute trauma is a safe and efficacious way to prevent or reduce inflammation and tissue damage associated with compartment syndrome (J Orthop Trauma, 28 (11): e263-e268) . A US patent has been granted with broad claims for the treatment of compartment syndrome with carbon monoxide.
Potential Advantages:
• Readily available gas
• Easily portable administration is possible
• Fast acting therapeutic effects
• May reduce the need for fasciotomy
Potential Applications:
- Prophylactic treatment of acute limb injuries to delay or prevent compartment syndrome
- Treatment of existing compartment syndrome to reduce the severity of muscle and limb damage
Keywords:
Compartment syndrome, carbon monoxide, inflammation, musculoskeletal, microvascular dysfunction, ischemia
