laerdal SIMETRY 212-55190 User manual

Lower Extremity Fasciotomy System
for Laerdal SimMan 3G
Laerdal Product No.
212-55190
212-55200
212-55210
User Manual Rev.1.1

FLTL-001-UOM-001, Rev.1.1
i
1 SYSTEM SUMMARY 1
2 INSTALLATION INSTRUCTIONS 2
2.1 SUPPLIES 2
2.2 SYSTEM CONFIGURATION 2
2.2.1 BASE UNIT 2
2.2.2 FOOT 3
2.2.3 FASCIAL SHEATHS 3
2.2.4 MUSCLE COMPARTMENTS 4
2.2.5 NERVES AND VEINS 4
2.2.6 SKIN LAYER 4
2.3 PREPARATION FOR USE 5
3 USER INSTRUCTIONS 11
3.1 INSTALLATION PROCESS 11
3.2 FASCIOTOMY PROCEDURE 13
3.2.1 LATERAL INCISION FASCIOTOMY PROCEDURE: 13
3.2.2 MEDIAL INCISION FASCIOTOMY PROCEDURE: 14
4 MAINTENANCE 15
4.1 SUPPLIES 15
4.2 CLEANING AND DRYING 15
4.3 REFURBISHMENT 15
Contents
Contents
Contents
Contents
Contents
Contents
Contents
Contents

FLTL-001-UOM-001, Rev.1.1
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1 SYSTEM SUMMARY
This document covers the preparation, use, and care of the Lower Extremity, 2 incisions, 4
compartment Lower Extremity Fasciotomy System for Laerdal. SIMETRI developed a training
system compatible with the Laerdal SimMan manikin that helps train in treating compartment
syndrome of the lower leg. The Lower Leg Fasciotomy training system’s reliability and
maintainability is critical to the objective of maintaining warfighters’ combat emergency response
readiness. Steps on how to assemble and maintain this system are detailed in sections below.

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2 INSTALLATION INSTRUCTIONS
2.1 Supplies
No supplies are required to install the Lower Extremity Fasciotomy System for Laerdal onto the
Laerdal SimMan 3G manikin.
2.2 System Configuration
2.2.1 Base Unit
The base unit is the main component of the Lower Extremity Fasciotomy System for Laerdal. All components
of the System for Laerdal will be sequentially applied to the base unit as outlined in Section 2.2. The base
unit, shown in Figure 1, is comprised of a support assembly at the top of the trainer and the simulated
bones extending downward from the hardware enclosure. The support assembly includes 3 built-in circular
attachment points and 1 metal hook attached to the bone structure for attaching the top of the muscle to
the unit. In addition, located at the bottom of the bone are 2 transverse holes that situate 4 magnetic pegs
for attaching the bottom of the muscle to the unit. Each magnetic peg is numbered to match the
corresponding muscle group and is placed in the following hole openings: lateral opening (peg #1),
posterior opening (peg #2), medial opening (peg #3), and the anterior opening (peg #4).
Figure 1. Base Unit for Laerdal

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2.2.2 Foot
The distal end of the unit has a bony foot projection with 2 transverse holes that situate 4
magnetic pegs (Figure 1) to serve as anchor points for muscular and Great Saphenous Vein
attachments. One of the last steps involved in assembling the trainer includes placing the foot
skin, seen in Figure 2, on the distal end of the base unit.
Figure 2. Foot
2.2.3 Fascial Sheaths
There are six fascial sheaths shown in Figure 3; each will be placed on individual muscle
compartments. Fascia #1 is the fascia for the deep posterior compartment. Fascia #2 is the fascia
for the superficial posterior compartment and divided into three components: the fascia marked
with L on the top left corner is the left third component of Fascia #2, the fascia marked with M on
the top right corner is the middle third component of Fascia #2, and the fascia marked with R on
the top right corner is the right third component of Fascia #2. Fascia #3 is the fascia for the
lateral compartment. Fascia #4 is the fascia for the anterior compartment. The fascia are marked
with the numbers 1, R, M, L, 3, and 4 on the top right corner, which identifies the muscle group
and location for assembly. The fascias include a release liner on the underside that is removed
prior to muscle application.
Figure 3. Fascial Sheaths
4
13
M
R
L

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2.2.4 Muscle Compartments
There are four muscle compartments in the lower extremity. Figure 4 displays (from left to right)
(1) the deep posterior compartment, (2) the superficial posterior compartment, (3) the lateral
compartment, and (4) the anterior compartment. The end labeled with a number indicates the top,
or superior, part of the muscle assembly. The deep posterior compartment includes the
neurovascular bundle and the lateral compartment includes the superficial perennial nerve.
Figure 4. Muscle Compartment
2.2.5 Nerves and Veins
There are two simulated vasculature attachments. The neurovascular bundle is adhered to the
deep posterior compartment (muscle #1). Figure 5 shows the great saphenous vein and its 1
point of attachment. The loop attaches to the metal hook. The 3 branches, from left to right,
attach to the corresponding pegs: posterior branch (peg #2), main branch (peg #1), and the
anterior branch (peg #4).
Figure 5. Great Saphenous Vein
2.2.6 Skin Layer
The skin layer, shown in Figure 6, is applied after the fascia-covered muscles have been

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attached to the base unit. It is the outermost layer and has an adipose layer on its underside.
Figure 6. Skin Layer
2.3 Preparation for Use
Once you become familiar with the components that make up the system, follow the steps below
to prepare the Lower Extremity Fasciotomy System for Laerdal for use.
1. Identify all components for the System (Figure 7).
a. Refer to the system configuration section for descriptions and images of all of
the components.
Figure 7. Components of the Fasciotomy System for Laerdal
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M
R
L

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2. Pair each muscle with its corresponding fascial sheath by matching the numbers on
the top right corner of the fascia with numbers on the top of the muscle tubing. The
muscle compartment and fascia numbering are as follows:
a. Pair deep posterior compartment (#1) with Fascia #1.
b. Pair superficial posterior compartment (#2) right third with Fascia R.
c. Pair superficial posterior compartment (#2) middle third with Fascia M.
d. Pair superficial posterior compartment (#2) left third with Fascia L.
e. Pair lateral compartments (#3) with Fascia section #3.
f. Pair anterior compartments (#4) with Fascia section #4.
3. Place fascia over corresponding muscle by matching the number on the fascia with
the number on the muscle tubing.
a. To prepare the fascia for installation, the fascia must be removed from its
release liner (Figure 8). Lay the fascia up right, so the fascia’s number is
on the right side. Begin to remove the fascia by pulling up while holding
the release liner down.
Figure 8. Removing Fascia from Release Liner
b. To adhere the fascia to the muscle (Figure 9), first correctly align the
muscle over the fascia. Lay the fascia upside down, so the adhesive side

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is up. Then place the muscle, facing up, over the right side of the fascia
so that only half of the muscle is superimposing the corner fascia. Bring
the fascia over the muscle and press firmly to remove creases. Flip the
muscle over to adhere the remaining fascia. Repeat for each muscle.
Figure 9. Placing Fascia on Muscle
c. To adhere muscle #3 and #4 together (Figure 10), place a two-sided
adhesive sticker below the superficial peroneal nerve on muscle #3.
Once adhered to muscle, remove the remaining release liner, place
muscle #3 and #4 side by side and adhere muscle #4 to #3.
Figure 10. Adhering Muscle 3 and 4

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Figure 11. Fascia Adhered to Muscle
4. Place each muscle compartment with adhered fascia (Figure 11) on the system base
unit.
a. Each muscle will have a superior corresponding anchor point on the base unit
that is specific to that muscle. The anchor points are numbered for each
muscle (see order of application below). Each muscle compartment will have a
circular opening at the inferior end, which will slide in its corresponding
magnetic peg on the bottom of the tibia. Again, the superior (top) end of the
muscle is identified by a number. Repeat this step for each muscular
compartment.
b. Order of application:
i. Deep Posterior Compartment (#1) - will be attached to the metal hook
on the top and peg #1 on the bottom (Figure 12).
Figure 12. Deep Posterior Compartment Attachment