Compartment syndrome of the lower extremity – acute and chronic
Leg pain is a common complaint among vascular patients. However, most pain is related to nerve problems or poor blood flow. Occasionally, the pain can be due to an increased pressure in the muscle compartments themselves.
Definition of Compartment Syndrome
Compartment syndrome is an elevated pressure within the fascial compartment. Fascia is a thin, non-elastic tissue that helps hold muscles, nerves, and vessels together. Think of a fascial compartment like a box. Inside the box are muscles, nerves, and vessels. If the muscles swell, there is less room in the box for nerves and vessels. The vessels can become compressed, resulting in a lack of blood flow to or from the affected area. When muscles have been deprived of blood flow for an extended length of time, such as in acute limb ischemia, and then the blood is restored with an intervention the muscles swell. This increased pressure causes compression of the nerves and vessels in the same compartment. This is an example of acute compartment syndrome. Some people may notice increased pain, usually in the calf muscles, after extensive exercise. This can be a symptom of chronic compartment syndrome.
Anatomy of Compartment Syndrome
The most common area to be affected is the lower leg. There are four compartments in the lower leg. These are the anterior, lateral, posterior superficial, and posterior deep compartments. All of these compartments must be opened to prevent muscle loss if compartment syndrome is suspected.
Causes of Compartment Syndrome
The primary cause of compartment syndrome is a reperfusion injury after loss of blood flow for an extended amount of time. The loss of blood flow could be from thrombosis, emboli, or a traumatic accident. When the oxygenated blood encounters the nutrient deprived tissue there is cellular damage that causes edema and swelling. Chronic compartment syndrome is far less common and results in increased swelling of the lower leg compartments during or after exercise.
Symptoms of Compartment Syndrome
- Pain – especially with passive motion of the foot
- Extremely tight/tender tissue
- Pulselessness due to compression of the artery – this is a very late finding
- Paresthesias/numbness from the compression of the nerve
Diagnosis of Compartment Syndrome
The diagnosis is typically based on clinical findings and the symptoms listed above. Most notably patients have pain with passive motion of the foot and numbness between the first and second toes. Most patients with compartment syndrome are already being seen by a medical professional, usually for a vascular issue. The nurses and physicians caring for the patient should be monitoring the patient for compartment syndrome. If symptoms occur, a physical exam is all that is necessary to confirm the diagnosis. Sometimes, there is some ambiguity to the diagnosis, especially with chronic compartment syndrome. A pressure monitoring device can be used to delineate compartment pressures.
Prevention of Compartment Syndrome
Ultimately, compartment syndrome is usually a result of treatment for acute limb ischemia. Patients can decrease their risk of compartment syndrome by decreasing their risk of acute limb ischemia. Patients should make sure their chronic medical conditions are consistently treated and
Am I At Risk?
Patients are at risk for compartment syndrome after any procedure for an acute loss of blood flow. It is imperative for the members of the healthcare team to monitor the patient to ensure that a compartment syndrome is treated to prevent any tissue loss.
Treatment of Compartment Syndrome
If the patient has acute compartment syndrome the facial compartments are opened for the entire length of the extremity. This ensures all of the muscles are allowed to expand as needed. The skin incisions are eventually closed with sutures or may require a skin graft several days after the initial procedure. For chronic compartment syndrome, these patients usually require excision of part of the fascia surrounding the compartment in question.
To learn more about treatment procedures for this condition please visit the following:
Patients in need of Compartment Syndrome treatment on Florida’s West Coast should locate a compassionate vascular surgeon who has the surgical skills necessary to perform this serious surgical operation for the benefit of their patients. Dr. J. Kazil is a leading vascular surgeon who has developed an impressive track record of successful cases in performing lower extremity fasciotomies. Dr. Kazil understands the important circumstances that drive the treatment with the accuracy and compassion that everyone expects from an accomplished vascular surgeon. Jenna Kazil, MD, FACS, RPVI is one of the best surgical specialist working as a general and vascular surgeon seeing patients from South Sarasota to East Desoto and Hardee to North Hillsborough to West Manatee and Pinell as counties. Patients requiring compartment syndrome treatment or fasciotomy of the lower extremity should contact Dr. Kazil at the Florida Surgical Clinic located in Bradenton, FL today to schedule an appointment with an unparalleled experienced doctor that possesses a unique blend of expert skills and compassionate care.