Pathophysiology and Management of Limb Compartment Syndromes

The pathophysiology of acute extremity compartment syndrome involves external compression or internal expansion within the compartment leading to increased tissue pressure, reduced capillary blood flow, tissue hypoxia and necrosis. Acute limb compartment syndrome in vascular surgery is mostly related to ischemia-reperfusion injury associated with acute ischemia or vascular trauma. The upper arm contains two compartments (anterior/posterior), forearm three (volar/lateral/dorsal), thigh three (anterior/medial/posterior), and lower leg four compartments (anterior/lateral/deep posterior/superficial posterior). The time from insult to the development of compartment syndrome may vary from minutes to hours. Any suspicion of acute limb compartment syndrome must lead to either prompt treatment or immediate further diagnostics which may include pressure measurement. Acute limb compartment syndrome should be treated with fasciotomy of all affected compartments. The lower limb is decompressed with anterolateral and posteromedial incisions. Incisions in skin and fascia need to be long enough to make tissues loose and allow for postoperative swelling. When fasciotomy is performed within 6 h of onset, the majority of extremities return to normal function but later fasciotomy is associated with significant complications including neuromuscular dysfunction and amputation.