![]() ![]() Tissue ischemia of only 1 hour is associated with reversible neuropraxia, whereas ischemia of 4 hours can induce irreversible axonotmesis. In general, longer periods of compartment syndrome and ischemia correlate with worse outcomes. Interstitial edema develops from tissue necrosis and further worsens compartmental swelling. Capillary collapse occurs when the compartment pressure surpasses the capillary perfusion pressure, leading to cellular ischemia and necrosis. 4 Intracompartmental bleeding leads to increased intracompartmental pressure, which increases venous capillary pressure. ![]() This was further elucidated and better characterized by Carter et al 3 in 1949 as muscle trauma leading to increased pressure within a muscular compartment that impairs blood supply, leading to necrosis.Ĭompartment syndrome occurs when the pressure within a defined compartmental space increases past a critical pressure threshold, thereby decreasing the perfusion pressure to that compartment. Labeled initially as a crush injury with impairment of renal function, the authors describe a swollen limb developing into shock, diminished pulse in the injured extremity, impending limb gangrene, progressive renal failure, and ultimately death. Bywaters and Beall better 2 defined the disease of compartment syndrome in a case series of British World War II victims in 1941. 1 The prevailing theory at the time was that tight bandages caused the ischemic insult. His landmark article detailed ischemia to a limb that when left untreated for several hours led to paralytic contracture. The sequela of compartment syndrome left untreated was first described by Volkmann in 1881. Rapid diagnosis and prompt, accurate treatment lead to the best outcomes. ![]() Lower extremity compartment syndrome is not uncommon and has the potential to cause devastating morbidity for patients and a high-risk medical-legal environment for physicians. ![]()
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