Abstract
We encountered two cases of localized compartment syndrome of the upper arm following prolonged operations, featuring use of a pneumatic tourniquet, to reattach multiple digits. Case 1 : The operative duration was 12 h and the pneumatic tourniquet was inflated for a total of 10h 35 min. A uniform cuff pressure of 280 mmHg was applied. Thirty minutes after surgery, circulatory insufficiency was evident in the reattached digits. The patient complained of severe pain and swelling of the upper arm. Fasciotomy of the arm was immediately performed, using longitudinal skin incisions in the medial and lateral aspects of the arm. The skin color of the reattached digits returned to normal. All digits survived. Case 2 : The operative duration was 9 h 35 min and the pneumatic tourniquet was inflated for a total of 4 h 25 min. The patient complained of increasing pain and swelling in the upper arm. Passive extension and elbow flexion caused severe pain. As no circulatory insufficiency was evident, arm fasciotomy was not performed. The post-operative period was uneventful, thus without any other complication. Compartment syndrome in the upper arm caused by prolonged application of a pneumatic tourniquet can trigger circulatory insufficiency in reattached digits.
