Acute compartment syndrome of the lower extremity: An update

Abstract

Acute compartment syndrome of the lower limb is a medical emergency, which can entail significant morbidity for the patient and which may have medico-legal implications for medical personnel. It affects about 3.1 per 100,000 inhabitants in the Western world, with a predominance of men and young people. Ischemia can be caused after an alteration of tissue perfusion, due to the arrangement of the muscles of the extremities in compact compartments, with little tolerance to variations in pressure, with irreversible changes at the muscular and nervous level, and multiorgan failure and death if not treated promptly. Trauma to the lower extremity associated with fracture is the main cause of acute compartment syndrome. Diagnosis can be made by clinical evaluation, using the classic six “P” of ischemia, or objectively by measuring intracompartmental pressure with specialized devices. Decompressive fasciotomy is a surgical procedure by which the fasciae of the muscle compartments are incised, allowing the pressure to be reduced at that level, and it is the only effective treatment for acute compartment syndrome. Postoperative complications are not uncommon, limb loss being the most serious of all. A correct knowledge and application of the surgical technique will avoid inappropriate procedures, which imply a greater risk of adverse results. We present a review of the fundamental aspects of this potentially catastrophic pathology.