Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction: the importance of early recognition and treatment

Compartment syndrome is caused by elevated interstitial pressure within the myofascial compartment. It rarely presents bilaterally in the gluteal region. A 49-year-old man fell 10 feet from a roof on his buttocks. He presented 10 hours after the injury with intense lumbar pain. Both glutei were exceptionally tense. There were no vascular injuries or sensory deficits. Compartmental pressures measured 60 mm Hg on the left side and 50 mm Hg on the right side. The patient was taken to the operating room for decompressive fasciotomy. The glutei compartments were released. He was taken once more to the operating room, requiring only minimal debridement. He was discharged the next week with no neurological deficit. Bilateral gluteal compartment syndrome is very rare with few cases reported in the literature. It has been associated with trauma, prolonged recumbence, surgical instrumentation, and illicit drug abuse. Early recognition is required to avoid the potential severe metabolic and physical deficits.

Download Full-text

Review of Flap Monitoring Technology in 2020

Facial Plastic Surgery ◽

10.1055/s-0040-1721105 ◽

2020 ◽

Vol 36 (06) ◽

pp. 722-726

Author(s):

Adam Jacobson ◽

Oriana Cohen

Keyword(s):

Head And Neck ◽

Free Flap ◽

Loss Rate ◽

Early Recognition ◽

Postoperative Patient ◽

Free Flap Monitoring ◽

Improved Outcomes ◽

Vascular Compromise ◽

Flap Monitoring ◽

Multiple Levels

AbstractAdvances in free flap reconstruction of complex head and neck defects have allowed for improved outcomes in the management of head and neck cancer. Technical refinements have decreased flap loss rate to less than 4%. However, the potential for flap failure exists at multiple levels, ranging from flap harvest and inset to pedicle lay and postoperative patient and positioning factors. While conventional methods of free flap monitoring (reliant on physical examination) remain the most frequently used, additional adjunctive methods have been developed. Herein we describe the various modalities of both invasive and noninvasive free flap monitoring available to date. Still, further prospective studies are needed to compare the various invasive and noninvasive technologies and to propel innovations to support the early recognition of vascular compromise with the goal of even greater rates of flap salvage.

Download Full-text

The treatment of tissue defects related to the compartment syndrome occurring in the fibula osteocutaneous free flap donor area with vacuum assisted closure therapy

Microsurgery ◽

10.1002/micr.22351 ◽

2014 ◽

Vol 35 (5) ◽

pp. 417-418

Author(s):

Adem Topkara ◽

Adem Ozkan ◽

Ramazan Hakan Ozcan

Keyword(s):

Compartment Syndrome ◽

Free Flap ◽

Vacuum Assisted Closure ◽

Donor Area ◽

Vacuum Assisted Closure Therapy ◽

Tissue Defects

Download Full-text

A Pain in the Butt: A Case Series of Gluteal Compartment Syndrome

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.3.51801 ◽

2021 ◽

Vol 2 (5) ◽

pp. 144-147

Author(s):

Jessica Jackson ◽

Kraftin Schreyer

Keyword(s):

Compartment Syndrome ◽

Clinical Presentation ◽

Case Series ◽

Morbidity And Mortality ◽

Emergency Physicians ◽

Laboratory Findings ◽

Diagnosis And Management ◽

Gluteal Compartment Syndrome

Introduction: Gluteal compartment syndrome is a rare and difficult-to-diagnose form of compartment syndrome. Case Series: We present three patients with gluteal compartment syndrome and review the clinical presentation, imaging, and laboratory findings that assist in diagnosis. Suggestions for more readily diagnosing gluteal compartment syndrome are provided. Conclusion: Emergency physicians must be familiar with the diagnosis and management of gluteal compartment syndrome to prevent the significant associated morbidity and mortality.

Download Full-text

Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

Case Reports in Orthopedics ◽

10.1155/2016/9127070 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

John E. Lawrence ◽

Duncan J. Cundall-Curry ◽

Kuldeep K. Stohr

Keyword(s):

Compartment Syndrome ◽

Kidney Injury ◽

Limb Ischaemia ◽

Delayed Presentation ◽

Neurological Improvement ◽

Tertiary Centre ◽

Acute Limb Ischaemia ◽

Nerve Recovery ◽

The Right ◽

Gluteal Compartment Syndrome

A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

Download Full-text

Early recognition imperative in compartment syndrome

Orthopaedic Nursing ◽

10.1097/00006416-198407000-00009 ◽

1984 ◽

Vol 3 (4) ◽

pp. 48

Author(s):

Mary Catherine Googe

Keyword(s):

Compartment Syndrome ◽

Early Recognition

Download Full-text

Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

Acute Medicine Journal ◽

10.52964/amja.0152 ◽

2007 ◽

Vol 6 (1) ◽

pp. 33-34

Author(s):

JPL Ong ◽

◽

LA Thomas ◽

Keyword(s):

Skeletal Muscle ◽

Renal Failure ◽

Acute Renal Failure ◽

Lower Extremity ◽

Compartment Syndrome ◽

Early Recognition ◽

Clinical Entity ◽

Threatening Condition ◽

Life Threatening ◽

Renal Support

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

Download Full-text

Bilateral compartment syndrome of the lower limbs after urological surgery in the lithotomy position: a clinical case

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.180117 ◽

2019 ◽

Vol 18 ◽

Author(s):

José Maciel Caldas dos Reis ◽

Lauro José Mendes Queiroz ◽

Pablo Ferreira Mello ◽

Renan Kleber Costa Teixeira ◽

Fábio de Azevedo Gonçalves

Keyword(s):

Compartment Syndrome ◽

Wound Closure ◽

Early Recognition ◽

Acute Compartment Syndrome ◽

Lower Limbs ◽

Lithotomy Position ◽

Activity Levels ◽

Urological Surgery ◽

Baseline Activity

Abstract Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes.

Download Full-text