RT Journal
A1 Ozer, Kagan
A1 Smith, Wade
T1 Limb Salvage in the Treatment of Total Muscle Necrosis of the Leg Due to Compartment SyndromeA Report of Three Cases
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2009
FD November 1
VO 91
IS 11
SP 2708
OP 2712
DO 10.2106/JBJS.H.01447
UL http://dx.doi.org/10.2106/JBJS.H.01447
AB 
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.