Lower Limb Compartment Syndrome

TLDR

The study aims to evaluate outcomes of patients undergoing delayed fasciotomy (>35 h) for lower limb compartment syndrome and to question the necessity of routine fasciotomy when diagnosis is delayed beyond 8–10 h. The authors conducted a retrospective review of five patients (nine delayed fasciotomies) who received treatment more than 35 h after injury. Among the five patients, the mean ischemic time was 56 h; one died, and four required lower‑limb amputation, with one amputation performed six months post‑injury due to a non‑functional foot.

Abstract

To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome.A retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should ideally have been performed earlier.Nine fasciotomies in five patients were identified where there was a delay of more than 35 hours after the injury. The average ischemic time was 56 hours (range 35-96 hours).One patient died of multiorgan failure and septicemia. The remaining four patients required lower limb amputation, because of local infection and septicemia. The one late amputation was performed 6 months after the injury, because the patient was left with a functionless insensate foot. Where recognition of an established compartment syndrome is delayed for more than 8 to 10 hours, we propose that the traditional inevitable fasciotomy be reassessed.