From the Guidelines
The treatment for suspected compartment syndrome is immediate surgical fasciotomy, which involves making incisions to release pressure within the affected compartment, as recommended by the most recent guidelines 1. This is a medical emergency requiring prompt diagnosis and intervention. If compartment syndrome is suspected based on clinical signs (pain out of proportion to injury, pain with passive stretch, paresthesia, pallor, paralysis, or pulselessness), the patient should be immediately referred to a surgeon for evaluation.
Key Considerations
- While awaiting surgery, all constrictive dressings, casts, or splints should be removed, and the affected limb should be kept at heart level (not elevated) 1.
- Measurement of compartment pressures may be performed to confirm the diagnosis, with pressures >30 mmHg or within 30 mmHg of diastolic blood pressure indicating the need for fasciotomy 1.
- Delay in treatment can lead to irreversible muscle and nerve damage within 4-6 hours, potentially resulting in permanent disability, contractures, or even necessitating amputation.
- Post-fasciotomy care includes wound management, pain control, and rehabilitation.
- There is no effective medical therapy that can replace surgical decompression for established compartment syndrome.
Clinical Signs and Diagnosis
- The clinical signs of compartment syndrome include pain, paresthesia, paresis, and pain with stretch, as well as skin examination and pink color, which complete the ‘6 Ps’ of ACS 1.
- Pulselessness and pallor are late signs that often reflect the irreversible nature of compartment syndrome 1.
- The diagnosis of compartment syndrome should be made early to achieve a good outcome, and the initial suspicion of a diagnosis of ACS is based on clinical findings 1.
From the Research
Treatment for Suspected Compartment Syndrome
The treatment for suspected compartment syndrome involves several steps, including:
- Removal of any constricting dressings or casts to reduce pressure on the affected limb 2
- Avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level 2
- Measurement of intracompartmental pressures using a pressure monitor to confirm the diagnosis 3, 4
- Surgical consultation for emergent fasciotomy to release the affected compartment and restore blood flow 2, 3, 4
- Resuscitation and management of complications, such as rhabdomyolysis 3
Surgical Decompression
Surgical decompression is the definitive treatment for compartment syndrome, and it should be performed as early as possible to prevent irreversible ischemic damage to muscles and peripheral nerves 2, 4. The goal of surgical decompression is to release the affected compartment and restore blood flow to the affected area.
Fasciotomy Closure
After fasciotomy, the wound should be managed to minimize complications and promote healing. Several approaches are available for fasciotomy closure, including early primary closure, gradual approximation, skin grafting, and negative pressure therapy 5. However, there is currently no consensus on the best method of closure, and the choice of technique depends on the individual patient's needs and the surgeon's preference.