EXTENSIVE FASCIOTOMY AND ESCHAROTOMY WOUND ARTEFACTS AT MEDICO LEGAL AUTOPSY: TWO CASE REPORTS
Keywords:
artefacts, fasciotomy, syndromeAbstract
Therapeutic artefacts are commonlyobserved at routine autopsy by the forensic pathologist. It is mostlyproduced during resuscitation and medical intervention. We report two unusual therapeutic artefacts cases i.e. extensive fasciotomy and escharotomy wound artefacts at medico legal autopsy. Extensive fasciotomy was done as a therapeutic measure for compartment syndrome in A 38-year-old male underwent minimal invasive coronary artery bypass surgery for coronary artery disease. During the postoperative period of the second day, the person’s condition suddenly deteriorated and he developed generalized swelling all over the body and was diagnosed with compartment syndrome. The fasciotomy procedure was done and the person died on the same day. The deceased’s relative suspected medical negligence against the treating doctor. The medicolegal postmortem examination was conducted at the Department of Forensic Medicine and Toxicology, AIIMS, New Delhi.
References
1. Saukko P, Knight B. In: The Forensic Autopsy. Knight’s Forensic Pathology. 4th ed. London:CRC press; 2016:98-101.
2. Forensic Pathology Principle and Practice. In. Artifacts of Resuscitation and Complications of Medical Therapy. 1st ed. Elsevier. 2005: 317
1. Matsen FA. Compartment syndrome: a unified concept. Clin Orthop. 1975; 113:8–14.
2. Matsen III FA, Krugmire Jr RB. Compartmental syndrome. Surg Gynecol Obstet. 1978; 147:943–9.
3. Janzing H, Broos P. Fasciotomies of the limbs: how to do it? Acta Chir Belg. 1998; 98:187–91.
4. BernotM, Gupta R, Dobrasz J, Chance B, Heppenstall RB, Sapega A. The effect of antecedent ischemia on the tolerance of skeletal muscle to increased interstitial pressure. J Orthop Trauma. 1996;10: 555–9.
5. Horwitz T. Ischemic contracture of the lower extremity. Arch Surg. 1940; 41:945–59.
6. Merle G, Harvey EJ. Pathophysiology of Compartment Syndrome. In Compartment Syndrome. Springer, Cham; 2019: 17-24.
7. Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twentyfirst century. HSS J. 2014; 10:143–52.
8. Branco BC, Inaba K, Barmparas G, Schnüriger B, Lustenberger T, Talving P, et al. Incidence and predictors for the need for fasciotomy after extremity
trauma: a 10-year review in a mature level I trauma centre. Inj. 2011;42: 1157–63.
9. Ritenour AE, Dorlac WC, Fang R, et al. Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma. 2008;64:S153– 62.
10. Donaldson J, Haddad B, Khan WS. Suppl 1: the pathophysiology, diagnosis and current management of acute compartment syndrome. The open orthopedicsjournal. 2014;8:185.
11. Tornetta P 3rd, Puskas BL, Wang K. Compartment syndrome of the leg associated with fracture: an algorithm to avoid releasing the posterior compartments. J Orthop Trauma.2016;30(7):381–6.
12. Bowyer MW. Lower extremity fasciotomy: indications and technique. Current Trauma Reports. 2015 Mar 1;1(1):35-44.
13. Orgill DP, Piccolo N. Escharotomy and decompressive therapies in burns. J Burn Care Res. 2009 (5):759-68.
14. Aggrawal A. Thermal burns In: Textbook of Forensic Medicine and Toxicology.1st ed. New Delhi: Avichal publishing company; 2014: 259
