Determining when ACS has caused irreversible damage to the nerves, vessels and/or muscle in a given compartment is difficult in the absence of a reliable clinical history. There is no convincing clinical data to indicate that multiple compartment pressure checks can help determine when irreversible damage has occurred. There is also no conclusive clinical data to suggest that elevated compartment pressures in a patient with known irreversible intracompartmental damage are an indication for fasciotomy. Fasciotomy performed on a limb with irreversible intracompartmental damage carries significant morbidity.
POSSIBLE HARMS OF IMPLEMENTATION
The indication for fasciotomy should be based on a reliable clinical history and exam. Assuming the viability of the compartment necrosis can lead to a missed diagnosis while performing fasciotomy on a necrotic compartment may lead to significant morbidity.
Determining reliable compartment pressure measurements that indicate the progression to irreversible ischemia would significantly aid the clinician seeking to avoid the morbidity of fasciotomy in this population.