The chronic venous compartment syndrome

Background: A chronic exertional compartment syndrome has only been observe d in athletes and soldiers. in the vast majority, the disease affects the a nterior compartment and the fibular muscle group, and only rarely the later al and dorsal muscle compartments. Muscle tissue necrosis does not occur. I n the course of venous diseases with a severe chronic venous stasis syndrom e, a chronic venous compartment syndrome develops that differs considerably from the familiar functional syndrome. The predominant symptom is an uncur able cuff ulceration on the lower leg. Patients and methods: From 1993 to 1996 a total of 16 patients with a chron ic fascial compression syndrome underwent surgery on 18 extremities. The cr ural fascia was resected and a mesh graft was applied. Results: In the group often controls with healthy veins the average pressur e in the deep compartment was 13, 6 mmHg (range 9-17 mmHg) lying down and 2 9, 9 mmHg (range 15-42 mmHg) standing up. In 14 patients with chronic fasci al compression syndrome, the average pressure was higher; measuring 21,1 mm Hg (range 8-47 mmHg) lying down and 62,5 mmHg (range 33-87) standing up. Af ter surgery, the pressure dropped to 15, 5 mmHg (range 5-24 mmHg) lying dow n and 34, 5 mmHg (range 10-58 mmHg) standing up, but did not fall as low as the average values recorded in the control group or in the patient's healt hy leg. The results from the standing up position were statistically signif icant (p = 0,003). Completed tomography showed major changes in the muscles indicating muscle atrophy and fatty degeneration. The crural fascia seemed to be incorporated in the scars of the subcutaneous tissue in large areas. After crural fasciectomy and healing of the ulceration, the tissue structu re of the muscles recovered. Conclusions: In chronic fascial compression syndrome, the trellis arrangeme nt of the collagen fibres becomes disordered. This results in a loss of fle xibility during muscle contraction. Every step causes an increase of intrac ompartmental pressure and microstructural injury. The consequence is resect ion of the crural fascia.