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KMID : 0371319770190040075
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Journal of the Korean Surgical Society
1977 Volume.19 No. 4 p.75 ~ p.85
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Anterior Tibial Compartment Syndrome
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崔昶植/Choi, Chang Sig
王弘實/金坤弘/尹大元/李昌周/Wang, Hong Shyr/Kim, Kon Hong/Yoon, Dae Won/Lee, Chang Joo
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Abstract
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A review of anterior tibial compartment syndrome is made with presentation of four clinical
cases who were seen at Hangang Sung Sim Hospital during last two year period. In two, this syndrome was developed after arterial injury of lower extremity. Case. 1 was 58-year-old male who sustained intimal tear and thrombosis of left popliteal artery after an automobile accident. Ischemic necrosis of anterior tibial- muscles was resulted after thrombectomy and faciotomy of posterior tibial compartment. Posterior tibial pulse was present throughout his postoperative course while dorsalis pedis pulse was abscent. Above-the-knee amputation was performed later. Case 2 was 40-year-old male who had his left femoral artery and vein ligated previously because of open wound of the thigh after motorcycle injury. Saphenous vein graft of the femoral artery was done 12 hours later, and the graft did function well. Anterior tibial compartmental syndrome was recognized on 8th day after the operation. Late fasciotomy and debridement of necrotic muscles in the compartment were done. The patient sustains foot drop which causes some disturbance of walking. Case 3. A 19-year-old man recovered from coma due to Yontan (carbon monoxide) intoxication after high pressure oxygen chamber treatment.Clinical findings were those of crush syndrome. Moderately severe renal damage was present but no myoglobulinuria was found. This patient developed massive necrosis of muscles in the -left tibial compartment after multiple swellings of both forearms and the left leg. He ended up with ischemic contracture of forearms and below the-knee amputation of the leg. Case 4. Twenty-eight years old pregnant woman had miscarriage of 36-week-old fetus after receiving of blunt trauma to her lower abdomen. Massive swelling of left leg from groin down to foot was developed in association with bluish discoloration and multiple bullae formation of leg skin. Clinical impression of phlegmasia cerulea dolens was made. Anticoagulant therapy with heparin administration alleviated the symptom but only to end up with massive necrosis of anterior tibial muscle group on later date. Above-the-knee amputation was the result.
Ai4thors feel that, in order to prevent permanent disability or amputation of the leg with this syndrome, followings are warranted to be emphasized. 1. Early recognition of the syndrome.
2. Early treatment of any vascular injury.
3. EaIrly decompression of anterior tibial compartment, before any irreversible injury of
muscles and nerve takes place, and the fasciotomy which executed at proper time and with proper technic.
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