Acute compartment syndrome following fibula flap harvest for mandibular reconstruction

Donor site morbidity for free fibula osteofasciocutaneous flaps has rarely been reported in the literature. We report on a case of acute compartment syndrome (ACS) in a 22-year-old male, following fibula flap harvest for mandibular reconstruction and arising after post-ischemic reperfusion damage. Dissection during this patient's surgery was unusually difficult. The skin defect was covered with a loose dressing while waiting for secondary grafting. Intracompartmental pressures measured by the Wick catheter technique confirmed the diagnosis of ACS. ACS is an unexpected complication after fibula flap harvest since the three compartments of the leg are opened during surgery. Only four cases of ACS have been reported in the literature. Analysis of this serious complication might lead to changes in the routine use of the pneumatic tourniquet in some selected cases. New automatic tourniquet systems might also be advantageous in such cases.