CONSENSUS RECOMMENDATION 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.