Compartment syndrome of the lower extremities: A pressing issue
Helene Harris MSN, RN
Carla J. Smith MS, RN

$7.95 		Nursing2013 Critical Care
March 2013 
Volume 8  Number 2
Pages 44 - 47
 
  PDF Version Available!

ABSTRACT
Compartment syndrome occurs when excess pressure develops within one of the body's many compartments (defined as spaces surrounded by fascia, which can't stretch to accommodate fluid changes).1 However, fluid accumulation (such as that caused by bleeding) isn't the only cause of compartment syndrome; pressure also can be from an external source, such as tight, constrictive dressings or casts. As pressure increases within the compartment, blood vessels, nerves, and muscles constrict. Tissue perfusion is limited, triggering the ischemia-edema cycle.2 Ischemia leads to cellular acidosis as cellular energy requirements are met through anaerobic metabolism. Capillaries dilate in an attempt to increase the supply of blood and oxygen. Plasma proteins and fluid leak out into the interstitial spaces, resulting in increased edema within the compartment. This further increases the compression on the vascular network, causing the cycle to continue.1Chronic exertional compartment syndrome is mostly due to exercise or a strenuous activity. The increased intramuscular pressure associated with repetitive muscle contraction may lead to transient ischemia and pain.2 Signs and symptoms aren't as severe or immediately limb-threatening as with acute compartment syndrome (ACS), but if the person continues exercising, ACS may develop. Pain usually subsides with rest and discontinuation of the exercise.ACS is considered an emergent situation because irreversible muscle and nerve damage can occur within 4 hours.3 Though it often occurs as a result of a traumatic event, such as a fracture, gunshot, crush injury, snakebite, or burn injury, acute compartment syndrome also can occur in patients without any apparent trauma.4 Patients who've undergone colorectal, gynecologic, and urologic surgical procedures are at risk for developing compartment syndrome in the extremities due to surgical positioning.5 Acute compartment syndrome also can develop in one or both legs after vein harvest for coronary

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