Purpose: Compartment syndrome of the leg is an exceptional (0.8% of leg fractures) but serious complication with a risk of muscle necrosis. The purpose of this work was to propose an original therapeutic approach to compartment syndromes that have progressed to the stage of muscle necrosis.

Material and method: Between November 1999 and January 2001, we treated eleven patients with acute compartment syndrome of the leg. There were ten men and one women, mean age 38 year (range 19–70). The causal mechanism was fracture of the two leg bones in nine patients (during the study period, 129 leg fractures were managed in the unit). For two patients the causal mechanism was prolonged compression. The compartment syndrome was present at admission in seven patients and developed after nailing in two. Emergency aponeurotomy was performed in all cases.

Results: Mean follow-up was six months, range 3 – 26 months. Outcome was favourable in six patients and the aponeurotomy was closed between day 5 and 10 (mean day 7), associated with a skin graft in some patients. Muscle necrosis developed in four patients. These patients were treated by wide muscle excision and immediate wound closure with aspiration drainage, followed by a prolonged adapted antibiotic regimen. Complete healing with total regression of the infectious syndrome was achieved. Partial recovery of sensory and motor function was obtained in all cases. One patient required a cross-leg flap for cover after infectious necrosis. One other patient aged 57 years died a few hours after aponeurotomy due to cardiac failure of undetermined origin.

Discussion: Compartment syndrome is a recognised surgical emergency. All authors recommend emergency aponeurotomy. There is no standard treatment after progression to muscle necrosis.

Conclusion: Muscle necrosis is not uncommon despite aponeurotomy (4 out of 11 patients in our series). In case of muscle necrosis, we propose wide excision and immediate wound closure associated with adapted antibiotics. Despite the muscle excision, partial recovery of sensorial and motor function of the foot was achieved several months after the initial treatment.