Based on the evaluation by the trauma team, injuries should be prioritized and corrected in the order of most critical to least critical. As in any patient with trauma, an ATLS evaluation should have been performed to assess all patient injures. Medically unstable conditions warranting further evaluation: Patients coming for lower extremity fasciotomy frequently have been involved in trauma. Preoperative evaluation should include obtaining electrolytes, renal function tests, and acid-base status. In severe compartment syndromes, rhabdomyolysis can lead to acute hyperkalemia and renal failure. In addition to related traumatic injuries, metabolic abnormalities must be evaluated. As such, preoperative evaluation will focus on other related injuries. Lower leg fasciotomies are usually performed in the setting of trauma. Urgent: Patients with delayed or slowly developing compartment syndrome, secondary to reperfusion, burn or positioning injury may tolerate a delay in surgery.Įlective: Fasciotomies performed for increased compartment pressures secondary to intense exercise or decreased serum osmolarity. The risk in delaying treatment is progressive muscle ischemia resulting in loss of limb and potentially loss of life depending on the extent of the compartment syndrome.Įmergent: Patients with acute traumatic compartment syndrome require emergent lower extremity fasciotomy. Frequently, this procedure is done in the setting of a traumatic injury and will be done in an emergent nature. The mechanism and acuity of the compartment syndrome will directly relate to the urgency to go to the operating room.

Once compartment syndrome is diagnosed, surgical fasciotomy is the standard treatment. What is the urgency of the surgery? What is the risk of delay in order to obtain additional preoperative information?

Compartments of lower leg