[Management of the compartment syndrome in hemophilic patients]

Diffuse bleeding in the muscles or localized hematomas are illness-specific factors increasing the possibility of a posttraumatic compartment syndrome in hemophiliac patients. Sufficient substitution of coagulation factor is the first step after trauma. The main principals of surgical treatment are:--a generous fasciotomy with a sufficient skin incision to allow adequate hemostasis under direct visualization. Localized hematomas should be evacuated;--fractures must be definitively stabilized as soon as possible. Therefore, internal fixation should be performed primarily whenever possible;--primary skin grafting of all skin defects to insure early wound closure. Intraoperatively, the underlying exposed surfaces of split thickness skin grafts and donor areas are sealed with fibrin glue. All surgery must be done under sufficient coagulation factor substitution, which has to be continued during wound healing and mobilization.