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Limb Salvage in the Treatment of Total Muscle Necrosis of the Leg Due to Compartment SyndromeA Report of Three Cases
Kagan Ozer, MD1; Wade Smith, MD1
1 Denver Health Medical Center, 777 Bannock Street, MC 188, Denver, CO 80204. E-mail address for K. Ozer: kagan.ozer@dhha.org
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Denver Health Medical Center, Denver, Colorado

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Nov 01;91(11):2708-2712. doi: 10.2106/JBJS.H.01447
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Prolonged high intracompartmental pressures, whether due to external causes or intracompartmental pathology, can lead to severe, if not total, necrosis of the muscle in the affected compartment(s). Aggressive treatment may reduce systemic complications and can help to improve the function as well as the survival of the patient. The treatment for acute compartment syndrome is early fasciotomy1. In the presence of severe crush injury, however, fasciotomy may lead to infection if any necrotic muscle remains after débridement and if wound and antibiotic therapies are not managed appropriately. Uncontrolled infection may lead to sepsis, amputation, and death. Currently, there is no objective method to predict the potential for the viability of compartment muscles prior to surgical release. Once the compartment has been released, the increased intracompartmental pressure usually returns to normal, and muscle viability is assessed by its response to physiologic stimuli (electrical or mechanical) and by its texture (turgor and rebound to normal following a forceps pinch). Any muscle that is found to be necrotic should be débrided immediately. Repeat returns to the operating room are necessary to reassess marginally surviving muscle and to look for further progression of necrosis. In some patients who have renal failure and/or multiple organ failure, radical débridement of marginally viable muscle or an amputation may be necessary to prevent worsening of the systemic inflammatory response, which could lead to death. In this report, we present the removal of all four compartments (anterior, lateral, superficial, and deep posterior, including both heads of the gastrocnemius muscle in all three patients) in a single session, resulting in a leg consisting of skin, the neurovascular bundles, and bone. Our long-term experience with this technique has shown that it is associated with low morbidity, and it reduces the initial complication rate as well as the time in the hospital, is well tolerated by the patient, and provides a reasonable long-term functional outcome without amputation. The patients were informed that data concerning the case would be submitted for publication, and they consented.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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