[Compartment syndrome. Principles of therapy]

Compartment syndrome can be classed as imminent, with moderate disturbances of muscular perfusion, no neurological symptoms and increasing tissue pressure, and manifest, with compromised circulation and loss of tissue function in the space and pathologic tissue pressure. When compartment syndrome is suspected, the most important immediate measure is wide splitting of any constricting dressings that have been applied. For decompression, the only adequate therapy, in imminent compartment syndrome, subcutaneous fasciotomy is required. The skin incision can be closed. Manifest compartment syndrome necessitates therapeutic fasciotomy, which means long incisions of skin and fascia, splitting of retinacula, excision of necrotic tissues, evacuation of hematoma and, if possible, rigid fixation of fractures. Skin closure is not permitted because of postoperative swelling, which can produce a rebound compartment syndrome. After 4-8 days edema decreases and the wound is closed by delayed sutures or a mesh graft. In the same session a second look operation for re-debridement of the tissues is done. Special problems arise in complex lesions of the foot, because of the thin layer of soft tissue coverage and the diminished blood supply to the bones of the foot. In the foot, decompression requires not only that the compartments of the short pedal muscles be opened, but also that the skin be adequately released.