en تخصصي Special گزارش مورد case report <span style="font-size:11pt"><span style="line-height:200%"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:12.0pt"><span style="line-height:200%">Fibula free flap donor site morbidity is usually minor, but <a name="_Hlk236383620">acute compartment syndrome </a>(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.</span></span></span></span></span><br> &nbsp; Acute compartment syndrome, Necrosis, Case report 0 0 http://wjps.ir/browse.php?a_code=A-10-1093-13&slc_lang=en&sid=1 Ali Moradi 100319475328460018073 100319475328460018073 No Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Ali Mirzaei 100319475328460018074 100319475328460018074 No Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Ali Aghaei Meybodi Ali.aghaimeybodi@gmail.com 100319475328460018075 100319475328460018075 Yes Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran