Twelve hours after femoral embolectomy for acute limb ischaemia, a patient develops severe calf pain out of proportion to findings, worsened by passive dorsiflexion of the toes, with a tense, tender calf. Doppler confirms restored arterial flow. What is the next step?

• A Immediate heparin infusion and observation for 6 hours
• B Elevation of the limb above heart level
• C Return to theatre for repeat embolectomy
• D Four compartment fasciotomy of the leg ✓

Explanation

Reperfusion of muscle after prolonged ischaemia causes capillary leak and oedema within the fixed fascial compartments, producing reperfusion compartment syndrome. Pain out of proportion with pain on passive stretch after successful revascularisation mandates urgent four compartment fasciotomy through lateral and medial incisions to release the anterior, lateral, superficial and deep posterior compartments. Limb elevation reduces perfusion pressure and worsens ischaemia, and delaying surgery risks irreversible myonecrosis and myoglobinuric renal failure.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.