Question

A 65-year-old male, presented with acute onset pain in right lower limb, with absent popliteal and below pulses. On admission, patient had ongoing pain and was having venous signals in foot with mild to moderate sensorimotor deficit.
He developed a painful calf after one hour of the procedure. What is the condition and how will you manage it?

Hint:

Compartment syndrome is a surgical emergency. Prompt recognition and fasciotomy are essential to prevent irreversible tissue damage.

Answer 1

Step 1: Understanding the new symptoms.
After the procedure, the patient develops a painful calf, which could suggest a complication. The likely condition is compartment syndrome, which occurs when increased pressure within a muscle compartment compromises blood flow, leading to ischemia and pain. This condition often arises after surgical interventions, trauma, or prolonged pressure.

Step 2: Diagnosis of compartment syndrome.
Compartment syndrome is typically diagnosed based on clinical signs such as:
1. Severe pain that is disproportionate to the injury, especially pain that increases with passive stretch of the affected muscles.
2. Tightness or swelling in the calf.
3. Sensory changes or paresthesia due to nerve compression.
4. Weakness in the affected muscles.
Diagnostic confirmation can be done by measuring intracompartmental pressure using a pressure monitoring device. If the pressure exceeds 30 mmHg, compartment syndrome is likely.

Step 3: Management of compartment syndrome.
The management of compartment syndrome is a surgical emergency, and the steps include:
1. Urgent fasciotomy: The main treatment is a fasciotomy, where the fascial compartments are surgically opened to relieve pressure and restore blood flow.
2. Monitoring: Close monitoring of the calf and limb after the fasciotomy to ensure adequate perfusion and healing.
3. Supportive care: Pain management and fluid resuscitation to support circulation.

Step 4: Conclusion.
The patient most likely has compartment syndrome, which requires immediate intervention via fasciotomy. Delaying treatment could lead to irreversible muscle and nerve damage.