Late management of compartment syndromes

Four patients have presented secondarily to this unit in recent years with rhabdomyolysis following prolonged compartment syndromes consequent upon drug overdoses or severe injury. Multiple complications arose due to the severe nature of the compartment syndrome itself and also its late and sometimes incomplete initial treatment. In two cases out of four a secondary amputation was required. Our experience with these cases demonstrates the importance of repeat examination under anaesthetic of the affected limbs following fasciotomy, even if apparently healthy granulation tissue is forming, and the value of persistent oedema and elevated creatine phosphokinase levels as markers of continued pathology. Observation of these factors may enable amputations and prolonged nerve palsies to be avoided in future patients.