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Subcutaneous Ischemic Biomarkers Closely Correlate with Intramuscular Biomarkers and Can Be Used to Detect Peripheral Compartment Syndrome in a Swine Model.
Bilal M. Chaudhry
*, Eddy C. Rios, Maria Bejar-Chapa,, Francisco Batiz-Fabela, Mitchell Kennedy, Daniah ALNafisee, Hiroshi Fujimaki, Jenna R. Lambert, Jaeyoung Lee, Katharine P. Playter, Aviv Liani, Giorgio Giatsidis
University of Massachusetts Chan Medical School, Worcester, MA
Background: Peripheral compartment syndrome (PCS) occurs in up to 10% of tibial fractures, with mortality rates as high as 15% in patients requiring fasciotomy. Diagnosis relies on clinical evaluation and intracompartmental pressure (ICP) measurements, which identify only 68% of cases. Intramuscular (IM) biomarkers have been shown to be reliable in detecting PCS. Given that IM perforators supply the overlying skin, we hypothesized that subcutaneous (SC) biomarkers closely correlate with IM metabolic changes and can detect PCS in a swine model.
Methods: Male Yorkshire swine (~50 kg) were used to model tourniquet-induced PCS of the anterior thigh bilaterally (n = 22 limbs). PCS was maintained for 6 hours and verified by serial ICP measurements. Microdialysis probes were placed in IM (n = 22) and SC (n = 11) tissue compartments to collect hourly interstitial fluid samples for glucose, pH, and lactate analysis. Tissue oxygenation (SrO2) and temperature were also monitored using thermal imaging. Diagnostic test accuracy (DTA), sensitivity (SN), and specificity (SP) were calculated for each metric.
Results: ICP increased after tourniquet inflation (pre: 15.6 mmHg ± 3.9 vs. 6 hr: 53.0 mmHg ± 36.8; p = 0.0024). SC and IM glucose had the strongest correlation (R2 = 0.931), followed by pH (R2 = 0.911), while lactate showed more heterogeneity (R2 = 0.667). IM glucose decreased significantly at hour 2; SC glucose at hour 3. SC glucose <6.6 mg/dL had a DTA of 75%, SN 0.91, SP 0.52. IM pH decreased significantly at hour 1; SC pH at hour 2. SC pH <7.17 had DTA 78%, SN 0.56, SP 1.0. IM lactate rose significantly at hour 1; SC lactate at hour 2. SC lactate >3.85 mg/dL had DTA 70%, SN 1.0, SP 0.4. SrO2 decreased significantly immediately after inflation (DTA 100% <58.5%), and temperature decreased significantly within 30 minutes (DTA 99.6% <27.7°C).
Conclusions: In a porcine model, SC glucose and pH are reliable early ischemic biomarkers for detecting PCS, while lactate shows greater variability. These findings warrant validation in a pilot clinical trial.
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