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Resection of Anterior and Lateral Muscle Compartments Does Not Preclude Limb Salvage and Functions
Eleanor Dunlap1, Suzanna Fitzpatrick, Felecia Jinwala
1In the Department of Surgery at the University of Maryland Medical Center, Baltimore, Maryland, Eleanor Dunlap, ACNP-BC, is Senior Nurse Practitioner; Suzanna Fitzpatrick, DNP, ACNP, FNP, is Senior Nurse Practitioner; Felecia Jinwala, MD, is Vascular Surgery Fellow; Charles Drucker, MD, is General Surgery Resident; and Khanjan Nagarsheth, MD, MBA, RPVI, is Attending Physician. Willie Lang, MD, is General Surgery Resident, Sinai Hospital of Baltimore, Maryland. The authors have disclosed no financial relationships related to this article. Submitted June 15, 2020; accepted in revised form September 25, 2020.
Background:
Fasciotomy with resection of nonviable muscle is often necessary when there is a delay in compartment syndrome (CS) diagnosis after revascularization. The reported rate of major amputation following missed CS or delayed fasciotomy ranges from 12% to 35%. Herein, the authors present a series of critically ill patients who experienced delayed CS diagnosis and required complete resection of the anterior and/or lateral compartments but still achieved limb salvage and function.
Methods:
A retrospective chart review identified five patients from April 2018 to April 2019 within a single institution who met the inclusion criteria. Patient charts were reviewed for demographic data, risk factors, time to diagnosis following revascularization, muscle compartments resected, operative and wound care details, and functional outcome at follow-up.
Results:
All of the patients developed CS of the lower extremity following revascularization secondary to acute limb ischemia and required two-incision, four-compartment fasciotomies. Further, they all required serial operative debridements to achieve limb salvage; however, there were no major amputations, and all of the patients were walking at follow-up.
Conclusions:
Delay in CS diagnosis can have devastating consequences, resulting in major amputation. In cases where myonecrosis is isolated to two or fewer compartments, complete compartment muscle resection can be safely performed, and limb preservation and function can be maintained with aggressive wound management and physical therapy.
