Acute Compartment Syndrome Following Delayed Donor Site Necrosis: A Case Report & Literature Review

Moradi, Ali; Mirzaei, Ali; Meybodi, Ali Aghaei

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Acute Compartment Syndrome Following Delayed Donor Site Necrosis: A Case Report & Literature Review

Ali Moradi¹

, Ali Mirzaei²

, Ali Aghaei Meybodi ^*³

1- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
2- Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
3- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran , Ali.aghaimeybodi@gmail.com

Abstract: (10 Views)

Fibula free flap donor site morbidity is usually minor, but acute compartment syndrome (ACS) is exceedingly rare. The sequential development of donor site necrosis followed by delayed ACS is scarcely reported. A 61-year-old man underwent mandibular reconstruction using a fibula osteocutaneous free flap. The donor site was closed under tension after a 120 min tourniquet time. By postoperative day 3, progressive edema, bullae, and ecchymosis developed. On postoperative day 10, the patient showed numbness, loss of motor function, nonpalpable pulses, and worsening necrosis. Based on the clinical findings, delayed ACS was diagnosed. Decompression through reopening the lateral incision revealed a markedly tense lateral compartment. The wound was managed with negative-pressure therapy, with planned skin grafting. Persistent foot drop and sensory loss remained. Seventeen relevant articles were identified, including eight donor-site ACS cases. Most presented in a delayed fashion associated with closure under tension, large or distal skin paddles, prolonged tourniquet use, or postoperative hematoma. Delayed diagnosis commonly led to lasting neuromuscular deficits. Donor-site necrosis can mask a developing ACS and delay recognition. Tension-free closure, cautious tourniquet use, and vigilant postoperative monitoring are essential. Early decompression remains critical to prevent irreversible morbidity.

Keywords: Acute compartment syndrome, Necrosis, Case report

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Type of Study: case report | Subject: Special