Additionally, wound closure has many proposed options, but current literature favors skin staples with an interlaced elastic band to minimize delays in wound closure. We conclude with a discussion about how medial release of the thigh for compartment syndrome is rare enough that careful consideration of the anatomy must be made before proceeding with the procedure. Given the rarity of compartment syndrome in all seven compartments of the leg, in this case, we report the development of full leg compartment syndrome in a 29-year-old male who fell asleep on a hard surface for an extended period following heroin intoxication, which was treated with seven compartment fasciotomies. Fasciotomy of the medial compartment of the thigh is exceedingly rare, and a review of the literature revealed only one reported case where compartment syndrome was present in both the thigh and lower leg compartments simultaneously. The interprofessional approach will provide the best method of early detection to facilitate early treatment and provide the best patient outcomes.Compartment syndrome of the lower extremities is a condition that can lead to permanent nerve and muscle damage if not treated in an emergent fashion. The anterior compartment is the most frequently missed of the four compartments during lower extremity fasciotomy. Therefore it is the responsibility of the senior doctors and the department management to ensure the ward staff has adequate training to recognize the symptoms, are familiar with pressure measuring equipment, and feel able to escalate appropriately. Introduction: Anterior compartment syndrome (ACS) of the lower extremity is a well-recognized surgical emergency. These are the members of staff who need the most training in recognizing compartment syndrome and who need to exercise the high index of suspicion and early escalation to a senior doctor who can initiate early aggressive treatment with fasciotomy. These boundaries are nonelastic, and form compartments within the extremity. Fasciotomy is the surgical gold standard. Eliason Anatomy The basis for learning the anatomy of the lower extremity, as it relates to fasciotomy, lies in a thorough understanding of the osseofascial boundaries that surround the muscles, blood vessels, and nerves. These ward staff, typically junior doctors, nursing, and health care assistants, have the most contact time with patients and are in the best position to detect increasing severity in symptoms. Patients with lower leg chronic exertional compartment syndrome are impaired due to exercise-related pain. Įarly recognition of compartment syndrome is best detected by those professionals who have regular contact with the patients in the ward. The goal of the surgery is to reduce the pressure within the compartments of the leg which is achieved by dividing the lining of each compartment so that it can. These considerations of irreversible nerve and muscle damage and high risk of infection change the risk-benefit analysis in missed compartment syndrome and negate the necessity for emergency surgery. Patients who underwent a delayed fasciotomy had twice the amputation rate and three times the mortality. In a 2008 study, a cohort of 336 combat patients received 643 fasciotomies (upper and lower limb included). It did demonstrate the infection rate is significantly higher in patients whose fasciotomies were delayed. Ĭonversely, another more recent study has shown that there is no difference in limb salvage rate when comparing early (12 hours) fasciotomy. However, fasciotomies performed after 12 hours resulted in only 8% regaining normal limb function. One study has demonstrated that fasciotomies performed within 6 hours resulted in almost complete limb function recovery, between 6 and 12 hours normal functional recovery rate was 68%. The primary relative contraindication to performing a fasciotomy is delayed presentation if the clinician suspects compartment syndrome of having been present for more than 12 hours, there is a potential risk of reperfusion injury. Symptoms such as cramps, paresthesia and muscle weakness can also be expe-rienced (4,5). Every decision to perform an emergency fasciotomy should be made by a senior team member and on a case-by-case basis in the context of the patient and the injury sustained. fasciotomy lower extremity patient-reported outcome systematic review Chronic exertional compartment syndrome (CECS) of the lower leg is an injury characterized by exercise-related pain and tightness typically affecting athletes and military personnel (1-3). The anterior compartment of the leg contains: Tibialis anterior. Lower extremity compartment syndrome is the most common due to the unique anatomy of the lower leg’s compartments. The lower leg anatomically divides into four compartments anterior, lateral, superficial posterior, and deep posterior. This section will explore the relative contraindications. The lower leg is the most frequent site of compartment syndrome and associated fasciotomy. There is no absolute contraindication to performing a fasciotomy.
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