Comprehensive Individualized Algorithm for the Management and Care of Upper Limb Ischemia/ Compartment Syndrome in Neonates as a Result of our Experience in Puerto Rico
Natalio Debs, MD; Cesar Castillo, MD
University of Puerto Rico School of Medicine, San Juan, Puerto Rico
Introduction: Upper limb ischemia/ compartment syndrome in neonates can be a devastating injury even if properly and promptly addressed. There are multiple causes for ischemia of the upper limb that can lead to compartment syndrome, which can be traumatic, due to a coagulopathy disorder, or of unknown etiology, among others. Materials & Methods: We did a retrospective review of our own experiences of three cases having upper limb ischemia/ compartment syndrome with their management and the care they received. Also a review of literature was performed using Pubmed, among others, using the term neonatal VolkmannÕs syndrome, neonatal Volkmann ischemic contracture, and upper limb ischemia assessing the way they were managed and cared for. By comparing what is reported in the literature in view of our own experiences we were able to come out with the recommendations of a comprehensive individualized algorithm to manage and care for these patients in a better way. Results: It is recognized that upper limb ischemia/ compartment syndrome in neonates is a rare condition and is almost always misdiagnosed. Proposed Algorithm: 1: Awareness to suspect and make the diagnosis. 2: Prompt intervention by highly specialized multi-specialty team. -Mainly by a surgeon with experience, such as a pediatric surgeon, hand pediatric surgeon, plastic pediatric surgeon, or a cardiovascular pediatric surgeon. 3: Vascular assessment and monitoring. 4: Compartment syndrome assessment and monitoring. 5: Coagulation profile assessment. 6: Neurological assessment and long-term follow-up. 7: Musculoskeletal assessment and long-term follow-up. 8: Co-morbid factors. 9: Hereditary factors. The above proposed algorithm will be explained in detail with their particular relevance. Conclusion: Proper management and care as proposed by our algorithm will definitely provide a uniform guidance to avoid further jeopardizing of limb survival and functionality in neonates with upper limb ischemia/ compartment syndrome.
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