Abstrakt
An acute compartment syndrome (ACS) is a surgical emergency which, if not well diagnosed and treated, can lead to serious impairment of the limb, multiorgan failure or even death. The syndrome is characterized by increased intracompartment pressure leading to decresed microcirculation and consequently nerve ischemia and muscle necrosis.
The aetiology of this state can be either exogenous (i. e.constrictive bandages) or endogenous (mostly reperfusion of ischemic limb due to trombotic or embolic clot). Diagnosing compartment syndrome is mostly made on the basis of clinical examination, assessment of patient's subjective complaints and intracompartmental pressure monitoring.
Early diagnosis is necessary to provide open dermatofasciotomy of all compartments, namely the anterior, lateral, superficial posterior and deep posterior, which is the most reliable method for compartment decompression. Consensus regarding the pressure at which fasciotomy should be performed has not been still made, also because it seems that ischemia is probably more responsible for neuromuscular damage than intracompartmental pressure.
However, most physicians indicate dermatofasciotomy in pressure ranging from 30 to 45 mmHg. Chronic compartment syndrome (CCES) is seen mainly in trained athletes or after prolonged exercise.
The vascular origin of the syndrome is debated, but many studies have shown that high tissue pressure affects the microcirculation of muscle, leading to ischaemia when the metabolic demand is increased by exercise. There is a physiological increase in intracompartmental pressure during exercise in normal subjects and there is no consensus as to the level of pressure which is diagnostic of chronic compartment syndrome.