Compartment syndromes

DEFINITION Compartment syndrome is a clinical and pathological syndrome where the pressure within an anatomical tissue compartment rises above the normal physiological value for that compartment and detrimentally alters the function of the tissues either temporarily or permanently. Acute compartment syndromes affecting the abdominal cavity and the fascial compartments of the limbs are those encountered in vascular surgery. ACUTE LIMB COMPARTMENT SYNDROME The importance of acute limb compartment syndrome (LCS) is that, if left untreated, it results in rhabdomyolysis with resultant release of potassium, myoglobin and other toxins into the systemic circulation, which can lead to renal and/or multi-organ failure. The mortality of acute renal failure and multi-organ failure is high. These patients require critical care which may involve dialysis and other organ support. Untreated LCS often necessitates amputation to prevent further acute systemic deterioration. If the immediate insult is survived without the need for amputation a permanently disabling ischaemic contracture may result. LCS arises due to the anatomical arrangement of muscles surrounded by restrictive, inelastic osteofascial envelopes. Increased pressure within these fascial compartments can occur as a result of extrinsic compression such as that from plaster casts or bandages, or increased volume of the contents of the compartment. The volume within the compartment can be increased as a result of enlargement of those tissues contained within the compartment (e.g.muscle oedema) or due to the presence of a pathological space-occupying mass (such as a haematoma or abscess).