Table of Contents
ISRN Vascular Medicine
Volume 2014 (2014), Article ID 218085, 9 pages
http://dx.doi.org/10.1155/2014/218085
Review Article

Threatening Inferior Limb Ischemia: When to Consider Fasciotomy and What Principles to Apply?

1Department of Thoracic and Vascular Surgery, Princess Paola Hospital, Rue du Vivier 21, 6900 Marche-en-Famenne, Belgium
2Department of Orthopedic Surgery, Princess Paola Hospital, Rue du Vivier 21, 6900 Marche-en-Famenne, Belgium

Received 13 September 2013; Accepted 30 December 2013; Published 4 March 2014

Academic Editors: B. Hambly, S. Takebayashi, and M. Zhang

Copyright © 2014 Vlad-Adrian Alexandrescu and Didier Van Espen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Inferior limb compartmental syndrome (CS) gathers a constellation of symptoms that traditionally refers to pathologically increased intramuscular and surrounding tissue pressure generally contained in nonexpansile leg spaces. It associates oftentimes reperfusion or traumatic injury. Intrinsic rigidity of these leg and foot closed compartments may enhance critical pressure risings with deleterious effects on specific vascular and nervous supply, with two main presentations: acute versus chronic display. For these situations, early fasciotomy plays the major role of releasing specific compartment hypertension and prevents deleterious tissue necrosis. Intervention is effective only if required upon precise indications (measured tissue pressure within 20 to 30 mm Hg of systemic diastolic pressure) and performed correctly in a timely fashioned approach. Any failure or delay in recognizing CS inevitably leads to adverse outcomes and jeopardy for secondary limb loss. When judiciously applied during or soon after limb-salvage revascularization technically successful fasciotomy may represent a major contributor in limb preservation. It accounts for a well-defined therapeutic proceeding available for any conscientious and well-briefed interventionist.