Nerves demonstrate functional abnormalities (paresthesias and hypoesthesia) within 30 min of ischemic onset.

Development of CS depends on many factors, including the duration of the pressure elevation, the metabolic rate of the tissues, vascular tone, associated soft tissue damage, and local blood pressure. As ischemia continues, irreparable damage to tissue ensues and myoneural necrosis occurs. It is imperative that all clinicians be aware of the traumatic as well as numerous non-traumatic causes (Table 1) of extremity CS, especially sepsis, massive resuscitation, and reperfusion as the diagnosis of CS in these settings is often delayed, as it is frequently not considered by many otherwise well-trained physicians.Ĭellular hypoxia is the final common pathway of all compartment syndromes. CS occurs either when compartment size is restricted or when compartment volume is increased. Groups of muscles and their associated nerves and vessels are surrounded by thick fascial layers that define the various compartments of the extremities which are of relatively fixed volume. The goal of this article is to review the pathophysiology, epidemiology, diagnosis, relevant anatomy, and treatment of CS with an emphasis on the proper performance of a two incision four compartment fasciotomy of the lower leg. Proper fasciotomy requires extensive knowledge of the anatomical landmarks and anatomy of the compartments of the extremities. Optimal outcomes result from early recognition of CS and aggressive, properly performed fasciotomy. As a result, otherwise well-trained surgeons are ill prepared to recognize and manage CS and to perform complete and adequate fasciotomies. The average number of fasciotomies reported in case logs submitted to the American Board of Surgery for 2013 graduates of US surgical residencies was 0.7, and the average number of fasciotomies reported by graduates of US vascular fellowships in the last decade has been between 0.8 and 2.0 per year. Bhattacharyya and Vrahas reported an average indemnity payment of $426,000 in nine cases settled between 19 in Massachusetts, and awards as high as $14.9 million have been made in cases of missed CS. The intramuscular pressures in the anterior compartment were normal at rest as well as during and after exercise eight months after the original fasciotomy in twenty-eight legs and eight months after the second fasciotomy in two legs.Disability resulting from CS is significant, and failure to diagnose or properly treat a CS is one of the most common causes of medical litigation, with significant malpractice liability. At an average length of follow-up of twenty-five months after fasciotomy for anterior compartment syndrome, functional capacity was unlimited or increased in eighteen patients (twenty-eight legs) and was unchanged in one patient (two legs) who had had compression of the superficial peroneal nerve. Two patients required a second fasciotomy due to recurrence of the chronic compartment syndrome.

The patient who had lateral compartment syndrome was relieved by fasciotomy of this compartment. In one of these patients, with bilateral nerve compression, both superficial peroneal nerves were anomalous. The patients who had compression of the superficial peroneal nerve were relieved by partial fasciectomy and fasciotomy of the lateral compartment. One patient also had lateral compartment syndrome in one leg. In addition, five of these patients (six legs) had compression of the superficial peroneal nerve: two before and three after fasciotomy. Thirty legs in nineteen patients, eleven with bilateral and eight with unilateral chronic anterior-compartment syndrome, were treated by fasciotomy.

Compartments of leg fasciotomy