![]() ![]() Normal compartment pressures of the lower leg in children. Staudt JM, Smeulders MJC, van der Horst CMAM. ![]() Diagnosis and treatment of acute extremity compartment syndrome. ![]() Von Keudell AG, Weaver MJ, Appleton PT, et al. Acute compartment syndrome of the upper extremity. Acute compartment syndrome of the extremities: an update. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. Acute compartment syndrome: update on diagnosis and treatment. Compartment monitoring in tibial fractures. Diagnosing acute compartment syndrome: are current textbooks misleading? Curr Orthop Pract. Oron A, Netzer N, Rosinsky P, Elmaliache D, Ben-Galim P. Die ischaemischen Muskellahmungen und-Kontrakturen. Intracompartmental pressure monitor system.Many fasciotomy wounds are unable to achieve delayed primary closure and undergo a split-thickness skin graft. Research articles continue to evaluate different and new surgical techniques to improve when delayed primary wound closure can occur. Fasciotomy of the involved compartments continues to be the widely accepted treatment of acute compartment syndrome, but it is not free from complications. A more complete pathophysiological understanding has led to improved education regarding early and late signs/symptoms to reduce delays in diagnosis which currently is subjective to physical exam findings. Delays in diagnosing acute compartment syndrome have been largely discussed in the literature with researchers evaluating new ways to enhance diagnosis. ACS is a surgical emergency that requires timely diagnosis and treatment in order to prevent further irreversible ischemic injuries and long-term morbidity. In such cases, surgical release of the skin layer is recommended, and can result in significant clinical improvement.Acute compartment syndrome (ACS) is defined as a progression of increasing interstitial pressure within a closed fascial compartment resulting in decreasing profusion to the tissues within the compartment which over time causes ischemic injury including muscle necrosis, irreversible nerve damage, contractures, and loss of limb. We propose that intact anatomical fascia need not be present for compartment syndrome to occur, and that the presence of constricting fibrous tissue or a well-encapsulating skin layer can result in the development of increased compartment pressures following reperfusion and significant muscle swelling. As these cases demonstrate, prior fasciotomy cannot be considered completely protective against future compartment syndrome. To our knowledge, these are the only reported cases of recurrent compartment syndrome in patients with previous fasciotomy who lacked identifiable intact fascia upon re-exploration. Recurrent compartment syndrome is a rare event in patients who have had previous fasciotomy. There were no previously reported cases of recurrent compartment syndrome in patients without intact fascia seen intraoperatively. In both cases, operative notes reported intact fascia. A literature review revealed one previous report describing two cases of repeat fasciotomy for recurrent compartment syndrome. Incisions over the lateral calf were left open with plans for secondary closure. Extensive skin incision resulted in significant symptomatic improvement. There was no evidence of intact fascia at surgery. Urgent compartment decompression was performed for a clinical diagnosis of compartment syndrome which was confirmed by the presence of bulging muscle. In each patient, post-operative course was complicated by rising CPK levels coupled with increasing pain, worsening sensorimotor function, and tense anterior and lateral compartments on exam. Emergent thrombectomy was performed in each case with successful revascularization. Both patients had a history of prior four compartment fasciotomy performed by a medial and lateral leg incision for compartment syndrome which developed following previous revascularization several years prior to this new ischemic event. Two patients presented with acute ischemic symptoms after occlusion of previous PTFE iliopopliteal lower extremity bypass grafts. A literature review was conducted using Pubmed database to search for previous reports of recurrent compartment syndrome in patients who had undergone previous fasciotomy. We identified two patients with recurrent compartment syndrome following previous fasciotomy. We report two patients with prior four compartment fasciotomy who developed recurrent anterior and lateral compartment syndrome following successful revascularization for occlusion of lower extremity bypass grafts. Montefiore Medical Center, New York, NY, USA. John Futchko, MD, Larry Scher, MD, Karan Garg, MD, Evan Lipsitz, MD. Compartment Release for Recurrent Compartment Syndrome: Report of 2 Cases and Review of the Literature ![]()
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