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Simulation education for lower limb fasciotomy: improving surgical trainee confidence in executing a time-critical limb-saving procedure
  1. Yogesh Nathdwarawala1,
  2. Owen Bodger2,
  3. Ian Pallister3
  1. 1 Department of Trauma & Orthopaedics, Nevill Hall Hospital, Abergavenny, UK
  2. 2 Education Research Working Group, Swansea University Medical School, Swansea, UK
  3. 3 Department of Trauma & Orthopaedics, Morriston Hospital, Swansea University Medical School, Swansea, UK
  1. Correspondence to Professor Ian Pallister, Morriston Hospital, Swansea University Medical School, Swansea SA2 8PP, UK; ianpallister{at}, i.pallister{at}

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Acute extremity compartment syndrome is a relatively rare but well-recognised complication seen in a wide variety of clinical situations from acute trauma to snakebites. Local swelling within a muscle compartment results in increasing tissue pressure resulting in critical ischaemia, severe pain and altered sensation. There is only one effective treatment and that is timely surgical decompression of the osteofascial compartments involved.1 Failure to do so results in crippling ischaemic muscle contractures and in extreme cases, death. The surgical treatment is technically simple, however the stumbling blocks to success lie in recognition along with the speed and completeness of the surgery. Each of the four osteofascial compartments in the leg (anterior, peroneal, deep and superficial posterior) must be fully decompressed.1

The development of the Management of Surgical Emergencies (MSE) course was supported by the Department for International Development with the International Federation of Surgical Colleges, Association of Surgeons of Great Britain and Ireland, and College of Surgeons of East, Central and Southern Africa.2 Following an initial pilot course, the need for integration of compartment syndrome education was identified by one of the authors (YN). In Africa, although a huge proportion of the clinical workload is obstetrics and general surgery, a surgeon is expected to deal with all conditions requiring surgery.

There are parallels between this truly time-critical emergency and cardiac arrest for which simulation training is well established, as it is …

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  • Contributors YN and IP conceived this project, YN collected the data and all three authors were closely involved in the interpretation of data, drafting the work, revising it critically and final approval of the version to be published. All agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests IP is Director of Trauma Simulation Ltd, a Swansea University spin-out company. The simulation model used in this Programme was provided gratis, but such models have since become available commercially through Trauma Simulation Ltd.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Via email from the corresponding author.

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