Therapy | Compartment syndrome (lodge syndrome)

Therapy

Therapy of Acute Compartment Syndrome Acute compartment syndrome is a surgical emergency and requires the fastest possible treatment. The treatment consists of immediate pressure relief of the affected muscles, through a so-called fasciotomy. Fasciotomy is a surgical procedure in which the layers of connective tissue that enclose the muscles are split, thus removing the pressure from the muscles.

Performing a fasciotomy: Through an incision in the skin (only the skin is cut through, underlying structures remain intact) at the affected area, an access to the fascia (connective tissue skin) is created, which encloses the muscles. If the fascia is exposed and clearly visible, it will also be split, resulting in rapid pressure relief of the muscles and nerves enclosed within. The muscles and nerves are spared and not injured during this procedure.

The wound is not immediately closed again, but remains open for the time being under sufficient tissue protection to prevent a renewed build-up of pressure. Only when the swelling in the tissue has subsided and no further swelling is to be expected will the wound be closed. For larger tissue defects, wound closure with a split skin is necessary.

Here, skin is taken from the patient’s thigh or other areas normally covered by clothing and transplanted onto the wound. When performed quickly, fasciotomy has a high success rate with a low complication rate. Decompression of the affected area within four hours does not usually result in permanent neuromuscular damage.

If more than 12 hours elapse before surgical decompression, irreversible damage can occur! Therapy of the chronic compartment syndrome Also for the chronic compartment syndrome, surgical therapy is the only possibility of relief. Conservative therapy approaches with training and shoe modifications as well as non-steroidal anti-inflammatory drugs (such as ibuprofen) are unsuccessful, if the level of sports activity as it was before the complaints should be reached again.

However, the therapy for chronic compartment syndrome does not represent an emergency and therefore precise diagnostics can be carried out without time pressure and a surgical procedure can be planned precisely with regard to cosmetics. Absolute indications for the therapy of a possible compartment syndrome are : Relative indications:

  • Clinical symptoms of compartment syndrome (severe pain, soft tissue swelling, tight skin, hardening, etc. )
  • A pressure measurement in endangered tissue above 35 mmHg
  • A pressure measurement in endangered tissue above 30 mmHg over 6 hours
  • Blood deficiency in the lower leg of over 4 hours
  • Severe burns
  • Compression trauma of the lower leg