Reperfusion injuries and compartment syndrome

Having spent 6 hours in theatre yesterday assisting with re-perfusing an acutely ischaemic leg in a patient with multiple previous vascular surgical history, today was a pretty busy day managing the post-operative complications that can arise due to reperfusion of the muscles. Serious complications of re-perfusion includes hyperkalaemia (release of potassium from dead/necrotic muscles), renal failure secondary to release of creatinine kinase into the circulation (again from ischaemic muscles) which is nephrotoxic, and compartment syndrome.

Having had no blood supply to the leg for few hours, the reperfusion of the muscles of the lower limb can lead to tissue/muscle oedema secondary to release of inflammatory mediators from damaged tissues. This initially leads to compromised venous return and therefore leads to venous congestion. This leads to further increase in the intra-compartmental pressures, and a vicious circle is set up. If the intra-compartmental pressure exceeds the perfusion pressure; this can lead to irreversible ischaemic damage to the muscles. If compartment syndrome develops, urgent release of the compartment pressure by a fasciotomy is required to prevent irreversible ischaemic damage to the muscle groups.

For further details on re-perfusion injuries and compartment syndrome; visit our website www.iwanttobeasurgeon.com (Website currently under construction)

Remember; If a patient has pain out of proportion to the injury sustained; suspect compartment syndrome, and early recognition and action can help save the limb.

Romesh