Eur J Vasc Endovasc Surg 13, 48-53 (1997)
Compartment Syndrome and Fasciotomy in Vascular Surgery.
A Review of 57 Cases
S. L. Jensen and J. Sandermann*
Department of Vascular Surgery, Aalborg Hospital, Denmark
Objective: To investigate the occurrence of compartment syndrome and the results of fasciotomy in vascular surgical
Design: Retrospective study of case records from 1980-1994.
Materials: Fifty-seven limbs in 53 patients had fasciotomies following surgical revascularisation. Fifty~three (93%) limbs
were acutely ischaemic, while four (7%) had undergone elective vascular surgery. Forty-four (77%) limbs had signs of
compartment syndrome, while 13 (23%) fasciotomies were prophylactic.
Methods: The fasciotomies were done as subcutaneous procedures (n = 40), as double-incision fasciotomies (n = 11), or
by an unknown method (n = 6). The skin incisions were closed primarily in 26 (46%) cases, delayed primarily in 11 (19%)
cases, and by skin grafting in eight cases (14%).
Results: Five (13%) subcutaneous fasciotomies required revision. Surgical debridement was required in four (7%) limbs.
At discharge, 36 (68%) patients had kept their limbs, 11 (21%) patients were amputated, and six (11%) had died. No
complications relating to the fasciotomies were observed.
Conclusions: Compartment syndrome is usually related to acute ischaemia and rarely following elective vascular surgery.
Subcutaneous fasciotomy does not always ensure sufficient decompression of all four lower leg compartments.
Complications related to fasciotomy are rare.
Key Words: Compartment syndrome; Fascia surgery; Ischaemia surgery; Postoperative complications; Reperfusion injury;
Compartment syndrome is a condition in which high
pressure within a closed fascial space reduces capil-
lary blood perfusion below a level necessary for tissue
viability. 1 In relation to vascular surgery the condition
is known as a post-ischaemic compartment syndrome,
in which tissue swelling following reperfusion of
ischaemic extremities leads to compartmental hyper-
tension. ~'2 This swelling is a consequence of a biphasic
ischaemia-reperfusion injury, in which tissue damage
initiated in the ischaemic phase is continued by the
reintroduction of oxygenated blood. 3"4 The ischaemia-
reperfusion injury appears to be mediated by the
interaction of oxygen derived free radicals, endothelial
factors and neutrophils. 5 Oxygen derived free radicals
can peroxidate the lipid component of cell mem-
branes, leading to enhanced capillary permeability. 3
Unless rapidly decompressed, compartment syn-
*Please address all correspondence to: Jes Sandermann, Vascular
Surgical Unit, Department of Surgery, Viborg Hospital, DK-8800
drome will eventually result in irreversible neu-
romuscular damage. 1 Fasciotomy has been recom-
mended as an adjunct in the treatment of ischaemic
limbs, 1'2'6 but uncertainties still remain. The clinical
diagnosis of compartmental hypertension is difficult,
and no absolute objective criteria for performing
fasciotomy exist, z'7 Complications, in particular infec-
tion, may be related to the procedure, which has lead
to debate of its appropriateness in ischaemic extre-
mities. 8-1° Several procedures for lower extremity
fasciotomy have been described, L6'7Al-~3 but there is
no agreement on which method is preferable.
This study was conducted to investigate the occur-
rence of compartment syndrome and the results of
fasciotomy in relation to vascular surgery.
Materials and Methods
The case records of all patients undergoing fasciotomy
at the Department of Vascular Surgery in Aalborg
from 1 January 1980 to 31 December 1994 were
1078-5884/97/010048 + 06 $12.00/0 © 1997 W. B. Saunders Company Ltd.
Compartment Syndrome and Fasciotomy 53
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Accepted 15 April 1996
Eur J Vasc Endovasc Surg Vol 13, January 1997