Six hours after femoral embolectomy for acute ischaemia of the right leg, a 70-year-old man has a tense, tender, swollen calf. Pain increases sharply on passive dorsiflexion of the toes, and the dorsalis pedis pulse is still palpable. What is the immediate next step?

• A Raise the leg and apply ice packs
• B Repeat embolectomy through the same arteriotomy
• C Urgent four-compartment fasciotomy of the leg ✓
• D Heparin infusion and observation for six hours

Explanation

Reperfusion of muscle after prolonged ischaemia causes capillary leak and oedema within the fixed fascial compartments, raising interstitial pressure until capillary inflow is cut off. Pain out of proportion with pain on passive stretch is the earliest reliable sign, and a palpable pulse does not exclude the diagnosis because compartment pressure can exceed capillary pressure while remaining below systolic. Delay risks myonecrosis, so the treatment is immediate fasciotomy, not observation.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.