INTRACOMPARTMENTAL PRESSURE DURING HYPERTHERMIC ISOLATED LIMB PERFUSION FOR MELANOMA AND SARCOMA

Side effects of isolated limb perfusion (ILP) include rhabdomyolysis, paresthesia, or nerve palsy, The increase in intracompartmental pressu re during ILP is thought to be linked to neuro- and muscular toxicity, and fasciotomy is recommended for protection, In 24 patients, intraco mpartmental pressure was measured, A flexible 5 F probe was placed int o the non-tumour-bearing compartment of the perfused limb, Interstitia l fluid pressure was measured using a piezoresistant tip, Compartmenta l pressure values were continuously recorded during and after ILP, The drugs used were a combination of doxorubicin, cisplatinum and melphal an or rhTNF-alpha combined with melphalan, The median overall compartm ental pressure prior to ILP was 13 mmHg (range: 11-21 mmHg); during th e heat-up phase the median pressure rose to 28 mmHg. During therapeuti c perfusion a further increase could be documented and the maximum pre ssure measured was 90 mmHg; the median of the pressure maxima of all p atients was 34 mmHg, During wash-out, at the end of the perfusion, a c lear reduction in compartment pressures could be observed and the medi an dropped to a value of 27 mmHg. In all patients a continuous decreas e in compartmental pressure could be recorded, reaching the pre-ILP va lues by 48 h post-operatively. A dramatic increase in compartmental pr essure during ILP can be observed by continuous monitoring, Because of our observation that during the wash-out phase elevated compartmental pressures return to normal, there is no general indication for a fasc iotomy. However, for patients maintaining a peak compartmental pressur e above a critical threshold of 35 to 40 mmHg fasciotomy may be indica ted.