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The chronic venous compartment syndrome.

W Hach1, F Präve, V Hach-Wunderle

  • 1Institut of Vascular Medicine, Frankfurt/Main, Germany.

VASA. Zeitschrift Fur Gefasskrankheiten
|July 20, 2000
PubMed
Summary

Chronic fascial compression syndrome, often linked to venous stasis, causes leg ulcers. Surgical resection of the crural fascia improved intracompartmental pressure and muscle tissue recovery in patients.

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Area of Science:

  • Vascular Surgery
  • Orthopedic Surgery
  • Sports Medicine

Background:

  • Chronic exertional compartment syndrome (CECS) is typically seen in athletes and soldiers, affecting anterior and fibular compartments.
  • A distinct chronic venous compartment syndrome arises from severe chronic venous stasis, characterized by persistent lower leg ulceration.
  • Unlike CECS, muscle necrosis is absent in chronic venous compartment syndrome.

Purpose of the Study:

  • To investigate the pathophysiology and surgical treatment of chronic fascial compression syndrome associated with chronic venous stasis.
  • To evaluate the effectiveness of crural fascia resection and mesh grafting in managing this condition.

Main Methods:

  • Surgical intervention involving crural fascia resection and mesh grafting was performed on 18 extremities in 16 patients between 1993 and 1996.

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  • Intracompartmental pressure measurements were taken in both resting and standing positions before and after surgery.
  • Computed tomography (CT) scans were utilized to assess muscle tissue changes.

    • Main Results:

    • Patients with chronic fascial compression syndrome exhibited elevated deep compartment pressures (21.1 mmHg resting, 62.5 mmHg standing) compared to controls (13.6 mmHg resting, 29.9 mmHg standing).
    • Post-surgery, compartment pressures decreased (15.5 mmHg resting, 34.5 mmHg standing), though not to control levels; the reduction in the standing position was statistically significant (p=0.003).
    • CT scans revealed muscle atrophy and fatty degeneration, with fascia incorporated into scar tissue; however, muscle tissue structure recovered after fasciectomy and ulcer healing.

    Conclusions:

    • Disordered collagen fiber arrangement in chronic fascial compression syndrome leads to reduced flexibility and increased intracompartmental pressure during muscle contraction.
    • Increased intracompartmental pressure causes microstructural injury, necessitating crural fascia resection.
    • Surgical intervention can lead to recovery of muscle tissue structure and healing of associated ulcerations.