![]() ![]() The worst of cases may potentiate cardiac arrhythmias, renal failure, shock, or hypothermia. Severity is based on extent of muscle compartments involved and duration of the ischemic changes. Eventual muscle necrosis leads to the release of myoglobin into the blood with associated metabolic acidosis and hyperkalemia. Anoxic damage to endothelial cells results in further increases to vessel wall permeability that, along with decreased venous outflow, perpetuates the local edema and pressure increases. Permanent damage to muscle tissue may result shortly after 4–8 hours of ischemia. As this gradient decreases, microvascular flow through capillaries falls, and inadequate perfusion of the tissue eventually results, causing ischemic changes to the tissues. Heightened tissue pressure corresponds with an increase in venous pressure, thus decreasing the arteriovenous gradient. Fascial compartments in the body have finite volumes with limited ability for elastic expansion, so pressure levels correspondingly increase. After a local insult, traumatic or others, volume increases to a compartment from bleeding or inflammation, leading to the onset of local tissue edema as a result. We hope the reader uses this chapter to assist in diagnosis and treatment of patients with potential compartment syndrome.Ĭompartment syndrome is the result of fascial compartment pressures surpassing perfusion pressure, causing tissue ischemia and eventual necrosis. Although fasciotomies are associated with increased blood loss and elevated risk of infection and commonly require split-thickness skin grafts in lieu of closure, they prevent irreversible ischemic tissue loss and potential for lifetime disability. Prompt fasciotomies with release of all involved muscular compartments prevent the life- and limb-threatening sequelae of a missed compartment syndrome. Compartment syndrome, unlike many musculoskeletal conditions, is much easier to treat than to accurately diagnose. Serial physical examinations by an experienced provider remain the best tool for accurate diagnosis, while intramuscular compartment pressure measurements are best used as an adjunct especially when a complete physical examination is not possible. ![]() Most practitioners associate lower extremity compartment syndrome with the leg, but other sites including the buttock, thigh, and foot can develop the same pathology. Rare presentations are even documented in association with diabetes mellitus, hypothyroidism, malignancy, viral-induced myositis, nephrotic syndrome, and bleeding disorders. Moreover, lower extremity compartment syndrome is most commonly associated with high-energy mechanisms of injury however, a high index of suspicion should be maintained with low-energy or penetrating trauma, vascular or crush injuries, and prolonged periods of immobility. KeywordsĪcute compartment syndrome is a surgical emergency that can threaten life and the limb. Acute compartment syndrome is a surgical emergency that can threaten life and the limb.
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