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OBJECTIVES:
We report two patients with prior four compartment fasciotomy who developed recurrent anterior and lateral compartment syndrome following successful revascularization for occlusion of lower extremity bypass grafts.
METHODS:
We identified two patients with recurrent compartment syndrome following previous fasciotomy. A literature review was conducted using Pubmed database to search for previous reports of recurrent compartment syndrome in patients who had undergone previous fasciotomy.
RESULTS:
Two patients presented with acute ischemic symptoms after occlusion of previous PTFE iliopopliteal lower extremity bypass grafts. Both patients had a history of prior four compartment fasciotomy performed by a medial and lateral leg incision for compartment syndrome which developed following previous revascularization several years prior to this new ischemic event. Emergent thrombectomy was performed in each case with successful revascularization. In each patient, post-operative course was complicated by rising CPK levels coupled with increasing pain, worsening sensorimotor function, and tense anterior and lateral compartments on exam. Urgent compartment decompression was performed for a clinical diagnosis of compartment syndrome which was confirmed by the presence of bulging muscle. There was no evidence of intact fascia at surgery. Extensive skin incision resulted in significant symptomatic improvement. Incisions over the lateral calf were left open with plans for secondary closure. A literature review revealed one previous report describing two cases of repeat fasciotomy for recurrent compartment syndrome. In both cases, operative notes reported intact fascia. There were no previously reported cases of recurrent compartment syndrome in patients without intact fascia seen intraoperatively.
CONCLUSIONS:
Recurrent compartment syndrome is a rare event in patients who have had previous fasciotomy. To our knowledge, these are the only reported cases of recurrent compartment syndrome in patients with previous fasciotomy who lacked identifiable intact fascia upon re-exploration. As these cases demonstrate, prior fasciotomy cannot be considered completely protective against future compartment syndrome. We propose that intact anatomical fascia need not be present for compartment syndrome to occur, and that the presence of constricting fibrous tissue or a well-encapsulating skin layer can result in the development of increased compartment pressures following reperfusion and significant muscle swelling. In such cases, surgical release of the skin layer is recommended, and can result in significant clinical improvement.