SlideShare ist ein Scribd-Unternehmen logo
1 von 15
Downloaden Sie, um offline zu lesen
COMPARTMENT SYNDROME
•DIAGNOSIS
•INVESTIGATION
•MANAGEMENT
DIAGNOSIS
• Clinical features Pain – most important.
Especially pain out of proportion to the injury
(child becoming more and more restless
/needing more analgesia)
• Other features like pallor, pulselessness,
paralysis, paraesthesia etc appear very late
and we should not wait for these things.
• Most reliable signs are pain on passive
stretching of the involved compartment, pain
on palpation of the involved compartment
and sensory deficit in the distribution of any
sensory nerve traversing the involved
compartment.
• Pressure measurement
– Normal compartment pressure is zero.
– There is inadequate perfusion and relative
ischemia when this rises to within 10 – 30 mm Hg
of diastolic pressure. There is no effective
perfusion when it is equal to the diastolic
pressure.
Whitesides Technique
slit catheter (Stryker)
• A difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy
MANAGEMENT
What should we do if pressure is raised
1.Split the plaster
– Compartmental pressure falls by 30% when cast
is split on one side,
– by 65% when the cast is spread after splitting.
– Splitting the padding reduces it by a further 10%
– complete removal of cast by another 15%.
– (Total of 85-90% reduction by just taking off the
plaster)
2. Elevate the limb
-Improve venous return (good) but
-decrease end capillary pressure
3. Circulation chart
- for monitoring (interval 15 minutes)
4. Measure compartment pressure
-A difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy.
When should fasciotomy be done?
• difference of less than 30 mmHg between
tissue pressure and the diastolic pressure
indicates need for fasciotomy.
• time interval between trauma and the
operation was the main factor in the poor
results; avg delay of 23 H due to secondary
referral.
• Morbidity from fasciotomy is minimal and
should be done as soon as possible.
• If facilities for measuring comparment
pressure are not available, clinical assesment
is very important
• The limb should be examine at 15 minutes
interval.
• If there is no improvement after removal of
splint and dressings, fasciotomy should be
done (muscle will loss after 4-6 of total
ischemia)
How to do fasciotomy
• Forearm
– Three compartments need to be
decompressed in the forearm –volar
(superficial and deep), dorsal and the mobile
wad of common extensor origin.
– Henry’s approach for volar aspect of forearm
– Thompson’s approach for the dorsal
compartment
.
• In the leg there are 4 compartments –the
anterior, the lateral (peroneal) superficial and
deep posterior.
• 3 techniques are recommended
– Fibulectomy,
– perifibular fasciotomy
– double incision fasciotomy.
• The wound should left open and inspected
after 2 days
• KIV for another debridement
• If healthy wound can be sutured or SSG or
simply allowed to heal by secondary intention.
Delayed Fasciotomy – is it safe ?
• If delayed more than 12 hours – Not safe
according to most papers.
• Why not ?
– Converts it into an open injury but with dead
tissue inside.
– Does not correct associated nerve or muscle
damage.
– Intact skin will act as a protection against infection
and should not be removed.

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

The management of a polytraumatised
The management of a polytraumatised The management of a polytraumatised
The management of a polytraumatised
 
Arterial tourniquet
Arterial tourniquetArterial tourniquet
Arterial tourniquet
 
Amputation and rehabilitation
Amputation and rehabilitationAmputation and rehabilitation
Amputation and rehabilitation
 
Principles of arthrotomy & arthrocentesis
Principles of arthrotomy & arthrocentesisPrinciples of arthrotomy & arthrocentesis
Principles of arthrotomy & arthrocentesis
 
Tourniquet seminaar
Tourniquet seminaarTourniquet seminaar
Tourniquet seminaar
 
Ortho
OrthoOrtho
Ortho
 
319 thoracolumbar trauma
319 thoracolumbar trauma319 thoracolumbar trauma
319 thoracolumbar trauma
 
Amputation
AmputationAmputation
Amputation
 
Electric burn injury- diagnosis and management
Electric burn injury- diagnosis and managementElectric burn injury- diagnosis and management
Electric burn injury- diagnosis and management
 
Amputation
AmputationAmputation
Amputation
 
Soft tissue and envenomation injuries
Soft tissue and envenomation injuriesSoft tissue and envenomation injuries
Soft tissue and envenomation injuries
 
Noon conference
Noon conferenceNoon conference
Noon conference
 
Emergency Thoracotomy
Emergency ThoracotomyEmergency Thoracotomy
Emergency Thoracotomy
 
Amputation Orthopaedics
Amputation OrthopaedicsAmputation Orthopaedics
Amputation Orthopaedics
 
Spinal anesthesia
Spinal anesthesiaSpinal anesthesia
Spinal anesthesia
 
Contusions
ContusionsContusions
Contusions
 
Introduction to anesthesia
Introduction to anesthesiaIntroduction to anesthesia
Introduction to anesthesia
 
Extern conference ortho
Extern conference orthoExtern conference ortho
Extern conference ortho
 
Controlling bleeding
Controlling bleedingControlling bleeding
Controlling bleeding
 
Interesting case pimpitcha
Interesting case pimpitchaInteresting case pimpitcha
Interesting case pimpitcha
 

Andere mochten auch

Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromeKanwal Nur
 
Compartment Syndrome
Compartment SyndromeCompartment Syndrome
Compartment SyndromeFaisal Shah
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromeAbino David
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromegroup7usmkk
 
Acute compartment syndrome
Acute compartment syndromeAcute compartment syndrome
Acute compartment syndromeSitanshu Barik
 
Paracetamol and sedative overdosage
Paracetamol and sedative overdosageParacetamol and sedative overdosage
Paracetamol and sedative overdosageAbino David
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromeRohit Vikas
 

Andere mochten auch (9)

Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Compartment syndrone
Compartment syndroneCompartment syndrone
Compartment syndrone
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Compartment Syndrome
Compartment SyndromeCompartment Syndrome
Compartment Syndrome
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Acute compartment syndrome
Acute compartment syndromeAcute compartment syndrome
Acute compartment syndrome
 
Paracetamol and sedative overdosage
Paracetamol and sedative overdosageParacetamol and sedative overdosage
Paracetamol and sedative overdosage
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 

Ähnlich wie Compartment syndrome

COMPARTMENT SYNDROME
COMPARTMENT SYNDROME  COMPARTMENT SYNDROME
COMPARTMENT SYNDROME Salman Syed
 
Compartment syndromes
Compartment syndromesCompartment syndromes
Compartment syndromesOladele Situ
 
Compartment syndrome.ppt
Compartment syndrome.pptCompartment syndrome.ppt
Compartment syndrome.pptStacyJuma1
 
Compartment syndrome
Compartment syndrome Compartment syndrome
Compartment syndrome SarmadGill
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromeAbdul Malek
 
Compartment syndrome -lukash adhikari (PAHS student)
Compartment syndrome -lukash adhikari (PAHS student) Compartment syndrome -lukash adhikari (PAHS student)
Compartment syndrome -lukash adhikari (PAHS student) Melukash
 
Carpel tunnel syndrome
Carpel tunnel syndromeCarpel tunnel syndrome
Carpel tunnel syndromeShruti Shirke
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndromeAvid Listener
 
Rehabilitation of dominant upper limb amputation
Rehabilitation of dominant upper limb amputationRehabilitation of dominant upper limb amputation
Rehabilitation of dominant upper limb amputationJoe Antony
 
Lower extrimity blocks
Lower extrimity blocksLower extrimity blocks
Lower extrimity blocksunmesh bedekar
 
Tha surgical approaches and principles no video
Tha surgical approaches and principles no videoTha surgical approaches and principles no video
Tha surgical approaches and principles no videoAsish Rajak
 

Ähnlich wie Compartment syndrome (20)

COMPARTMENT SYNDROME
COMPARTMENT SYNDROME  COMPARTMENT SYNDROME
COMPARTMENT SYNDROME
 
Escharotomy
EscharotomyEscharotomy
Escharotomy
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Compartment syndromes
Compartment syndromesCompartment syndromes
Compartment syndromes
 
compartment syndrome
compartment syndromecompartment syndrome
compartment syndrome
 
Compartment syndrome.ppt
Compartment syndrome.pptCompartment syndrome.ppt
Compartment syndrome.ppt
 
Fasciotomy & Escharotomy
Fasciotomy & Escharotomy Fasciotomy & Escharotomy
Fasciotomy & Escharotomy
 
Compartment syndrome
Compartment syndrome Compartment syndrome
Compartment syndrome
 
COMPARTMENT SYNDROME.pptx
COMPARTMENT SYNDROME.pptxCOMPARTMENT SYNDROME.pptx
COMPARTMENT SYNDROME.pptx
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
COMPARTMENT SYNDROME
COMPARTMENT SYNDROMECOMPARTMENT SYNDROME
COMPARTMENT SYNDROME
 
Compartment syndrome -lukash adhikari (PAHS student)
Compartment syndrome -lukash adhikari (PAHS student) Compartment syndrome -lukash adhikari (PAHS student)
Compartment syndrome -lukash adhikari (PAHS student)
 
Carpel tunnel syndrome
Carpel tunnel syndromeCarpel tunnel syndrome
Carpel tunnel syndrome
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Rehabilitation of dominant upper limb amputation
Rehabilitation of dominant upper limb amputationRehabilitation of dominant upper limb amputation
Rehabilitation of dominant upper limb amputation
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
Compartment syndrome
Compartment syndromeCompartment syndrome
Compartment syndrome
 
tourniquet seminaar
tourniquet seminaartourniquet seminaar
tourniquet seminaar
 
Lower extrimity blocks
Lower extrimity blocksLower extrimity blocks
Lower extrimity blocks
 
Tha surgical approaches and principles no video
Tha surgical approaches and principles no videoTha surgical approaches and principles no video
Tha surgical approaches and principles no video
 

Kürzlich hochgeladen

SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 

Kürzlich hochgeladen (20)

SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 

Compartment syndrome

  • 2. DIAGNOSIS • Clinical features Pain – most important. Especially pain out of proportion to the injury (child becoming more and more restless /needing more analgesia) • Other features like pallor, pulselessness, paralysis, paraesthesia etc appear very late and we should not wait for these things.
  • 3. • Most reliable signs are pain on passive stretching of the involved compartment, pain on palpation of the involved compartment and sensory deficit in the distribution of any sensory nerve traversing the involved compartment.
  • 4. • Pressure measurement – Normal compartment pressure is zero. – There is inadequate perfusion and relative ischemia when this rises to within 10 – 30 mm Hg of diastolic pressure. There is no effective perfusion when it is equal to the diastolic pressure.
  • 7. • A difference of less than 30 mmHg between tissue pressure and the diastolic pressure indicates need for fasciotomy
  • 8. MANAGEMENT What should we do if pressure is raised 1.Split the plaster – Compartmental pressure falls by 30% when cast is split on one side, – by 65% when the cast is spread after splitting. – Splitting the padding reduces it by a further 10% – complete removal of cast by another 15%. – (Total of 85-90% reduction by just taking off the plaster)
  • 9. 2. Elevate the limb -Improve venous return (good) but -decrease end capillary pressure 3. Circulation chart - for monitoring (interval 15 minutes) 4. Measure compartment pressure -A difference of less than 30 mmHg between tissue pressure and the diastolic pressure indicates need for fasciotomy.
  • 10. When should fasciotomy be done? • difference of less than 30 mmHg between tissue pressure and the diastolic pressure indicates need for fasciotomy. • time interval between trauma and the operation was the main factor in the poor results; avg delay of 23 H due to secondary referral. • Morbidity from fasciotomy is minimal and should be done as soon as possible.
  • 11. • If facilities for measuring comparment pressure are not available, clinical assesment is very important • The limb should be examine at 15 minutes interval. • If there is no improvement after removal of splint and dressings, fasciotomy should be done (muscle will loss after 4-6 of total ischemia)
  • 12. How to do fasciotomy • Forearm – Three compartments need to be decompressed in the forearm –volar (superficial and deep), dorsal and the mobile wad of common extensor origin. – Henry’s approach for volar aspect of forearm – Thompson’s approach for the dorsal compartment .
  • 13. • In the leg there are 4 compartments –the anterior, the lateral (peroneal) superficial and deep posterior. • 3 techniques are recommended – Fibulectomy, – perifibular fasciotomy – double incision fasciotomy.
  • 14. • The wound should left open and inspected after 2 days • KIV for another debridement • If healthy wound can be sutured or SSG or simply allowed to heal by secondary intention.
  • 15. Delayed Fasciotomy – is it safe ? • If delayed more than 12 hours – Not safe according to most papers. • Why not ? – Converts it into an open injury but with dead tissue inside. – Does not correct associated nerve or muscle damage. – Intact skin will act as a protection against infection and should not be removed.