Serum Biomarkers in Late/Missed ACS
In the absence of reliable evidence, it is the opinion of the work group that serum biomarkers do not provide useful information to guide decision making when considering fasciotomy for a presumed late-presentation or missed acute compartment syndrome.
Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS, AOFAS, and SOMOS

Rationale

All information available and consideration of the risk of a potentially late fasciotomy should be considered.

POSSIBLE HARMS OF IMPLEMENTATION

As noted in this CPG, the diagnosis of ACS at any time point after injury is difficult, uncertain, and potentially controversial, with significant practice variation present. Laboratory value abnormalities alone do not provide sufficient guidance to indicate when fasciotomy is needed. Presuming a missed ACS based on biomarkers may lead to performing fasciotomy on a necrotic compartment with resultant complications. Surgeons should consider irrigation and debridement of an affected limb when faced with evidence of significant infection in an extremity with a presumed missed ACS.

FUTURE RESEARCH

While reliable diagnostic criteria for ACS may remain elusive, research should be geared towards determining serum markers that differentiate between reversible ischemia caused by ACS and indicators of neuromuscular necrosis that increases the morbidity of fasciotomy.


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