Limb preservation with radical muscle debridement in crush-related compartment syndrome: a case report from an earthquake survivor.

Abstract

The role of fasciotomy in the treatment of lower extremity crush injuries remains controversial. Late fasciotomy wounds are known to be associated with sepsis and amputation. This report presents the results of a limb-saving treatment procedure for a patient with crushinduced leg compartment syndrome who had undergone fasciotomy before admission. A 36-year-old male patient, trapped under rubble for 37 hours, presented with purulent-necrotic drainage from the fasciotomy site of his right leg. Two radical muscle debridements were performed to excise all necrotic muscles. No signs of sepsis developed postoperatively, and renal function normalized with the aid of hemodialysis. At the 1-year follow-up, the patient was able to walk with the assistance of a walker. Semmes-Weinstein monofilament testing showed a positive response to a 4.31-mm monofilament over the plantar aspect of the first metatarsal head; however, no sensation was detected in the dorsal aspect of the foot. This case highlights that radical muscle debridement may be considered a limb-preserving surgical option in patients with crush-induced leg compartment syndrome, as it can prevent sepsis, improve renal and metabolic function, and potentially obviate the need for amputation.