Extensive Muscle Resection During Fasciotomy For Missed Compartment Syndrome Does Not Preclude Limb Salvage After Revascularization
Suzanna Fitzpatrick, DNP, Nora F. Dunlap, MS, Felecia Jinwala, MD, Williw Lang, MD, Khanjan Nagarsheth, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVES: Resection of non-viable muscle is often necessary during fasciotomy when there is a delay in diagnosis of compartment syndrome (CS) after revascularization. The reported rate of major amputation following missed CS or delayed fasciotomy ranges from 12 to 35%. Herein, we present a series of critically ill patients who had a delay in diagnosis of CS that required entire compartment muscle resections but still achieved limb salvage.
METHODS: A retrospective chart review identified 5 patients from April 2018-April 2019 within a single institution who had delayed diagnosis of lower extremity CS following revascularization. Patient charts were reviewed for demographics and risk factors, time to diagnosis following revascularization, muscle compartments resected, operative and wound care details and functional outcome at follow-up.
RESULTS: All the patients (5/5,100%) developed compartment syndrome of the lower extremity following revascularization for acute limb ischemia (ALI) and 100% required 2-incision, 4 compartment fasciotomies. The mean age of these patients was 48.8 years (range 8-74 years). The patients were predominantly female (4/5, 80%). Cardiovascular disease was present in 80% (4/5) of patients, and a history of prior lower extremity revascularization in 80% (4/5). All the patients were critically ill (5/5,100%) and mean time from recognition of sensory, motor or pulse exam change to fasciotomy was 14 hours (range 10-18 hours). One compartment was resected in 40% (2/5) patients, two compartments were resected in 40% (2/5) and three compartments were resected in 20% (1/5) of patients. All patients received negative pressure wound therapy following fasciotomy. All patients (5/5, 100%) required serial operative debridements with a mean of 4.2 debridements (range 1-9) to achieve limb salvage with a 0% rate of (0/5) major amputation. After aggressive physical therapy, all the patients are bearing weight on their lower extremities with 80% (4/5) walking. CONCLUSIONS: Delay in diagnosis of compartment syndrome can have devastating consequences resulting in major amputation. In cases where myonecrosis is isolated to two or fewer compartments, complete compartment muscle resection can be safely performed, and limb preservation and function can still be maintained with aggressive wound management and physical therapy.
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