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Utilization of Fluorescence Microangiography in Pediatric Acute Compartment Syndrome: A Case Report
Nicole A Bauerly1, Kimberly L Bobbitt2, Stephanie Kvas3
1Chief, Department of Foot and Ankle Surgery, Hennepin Healthcare, Minneapolis, MN.
Insights
Acute compartment syndrome in children is rare but serious. This case highlights serial microangiography as a tool to monitor healing and prognosis in pediatric foot compartment syndrome.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Vascular Surgery
Background:
- Acute compartment syndrome (ACS) is a surgical emergency requiring prompt diagnosis and intervention to prevent limb damage.
- Pediatric ACS, particularly isolated pedal compartment syndrome, is infrequently reported and poses diagnostic challenges due to communication barriers in young patients.
Observation:
- A 5-year-old female presented with ACS of the left foot 26 hours post-crush injury.
- Treatment involved emergent fasciotomy and 20 hyperbaric oxygen therapy sessions.
- Serial fluorescence microangiography was used to track acute digital ischemia progression.
Findings:
- Microangiography demonstrated improved perfusion in the dorsolateral midfoot and digits 3, 4, and 5 over 3 weeks.
- These findings correlated with clinical examination improvements.
- The patient experienced autoamputation of distal digits 4 and 5 without complications.
Implications:
- Serial microangiography can effectively monitor ischemia in pediatric ACS.
- This technique may offer prognostic insights for acute pediatric compartment syndrome.
- The case underscores successful management of pediatric pedal ACS with fasciotomy and hyperbaric oxygen therapy.
Abstract:
Acute compartment syndrome is a critical condition, most commonly arising as the result of high-energy trauma, fracture, and crush injury. Early diagnosis and treatment are imperative to avoid permanent functional damage to the affected extremity. Although isolated pedal compartment syndrome is well studied in adults, in the pediatric population, it has been seldom reported. Pediatric patients pose a unique challenge when diagnosing compartment syndrome. Their inability to appropriately verbalize symptoms and participate in physical examinations often causes a delay in diagnosis. We present the case of a 5-year-old female who developed compartment syndrome of her left foot 26 hours after sustaining an isolated crush injury to the distal forefoot. Her treatment included emergent fasciotomy in combination with 20 hyperbaric oxygen therapy treatments. The progression of her acute digital ischemia was monitored by using serial fluorescence microangiography studies performed at 17 hours, 7 days, and 3 weeks postinjury. Throughout these serial studies, improvement in hypofluorescence was noted involving the dorsolateral midfoot, as well as digits 3, 4, and 5, which correlated with physical examination. The patient went on to uneventfully autoamputate the distal aspects of digits 4 and 5 within 4 months of injury. At the 12-month follow-up visit, she denied any pain, sensory deficits, or functional disability and had returned to all preinjury activities. Our case study demonstrates the use of serial microangiography to monitor progression of acute ischemia associated with acute pediatric compartment syndrome and discusses prognostic capabilities.
