Thigh Compartment Syndrome after Acute Ischemia

Thigh compartment syndrome (TCS) is a poorly recognized clinical condition that may follow reperfusion of acutely ischemic thigh muscles. The anterior muscle group appears to be at greatest risk because of its layered arrangement. Intense pain, swelling, and elevated compartment pressures characterize the early presentation in the affected muscle group. If untreated myonecrosis, myoglobinuria, and renal failure may result. TCS was observed in a patient who was treated for a gunshot wound to the left thigh. The superficial femoral and profunda femoris veins as well as the profunda femoris artery were disrupted. The superficial femoral vein and profunda femoris artery injuries were repaired but the mangled branches of the profunda femoris vein were ligated. Postoperatively he developed intense thigh pain, swelling, and elevated compartment pressures. Lateral thigh fasciotomy, extensive debridement of necrotic muscle, and delayed wound closure resulted in a full recovery. Physicians should recognize the numerous clinical circumstances that could lead to TCS--particularly those associated with trauma or physical activity. Timely recognition and intervention may be both limb and life saving. Associated irreparable injury to the profunda femoris vein may aggravate this condition.