55 year old man on disability due to cardiac condition, otherwise fairly active. Believed to have suffered heart attack; undergoes open heart surgery at hospital. Vein taken from leg for the procedure. His leg became severely swollen and he developed compartment syndrome, which may not have been timely recognized or treated. Two fasciotomies were required since the first didn’t work. On wound vac for 2 months and months of PT. He suffered nerve damage and now has drop foot, requiring him to wear a special shoe/boot to keep the foot upward. He has chronic pain and is on Neurontin. Is it an accepted risk of the procedure?

EXPERT RESPONSES

After fasciotomy, wound VAC and skin grafts are sometimes needed, so this is “damages”.

Reason for compartment syndrome not truly known, but failure to diagnose and treat in a timely fashion is negligent. Failure to do an adequate fasciotomy the first time could be negligent, and the delay until the second fasciotomy may have been avoidable. – Dr. MF

Never heard of a compartment syndrome in the leg after a CABG. Was there an injury there intra-op? HITT? A bleed in the leg that was missed? Seems like an extremely rare complication. Missing it is a major problem because of the subsequent nerve damage. Didn’t they examine the leg post-op? It’s not easy to miss… Sounds like this may be a case. – Dr MC

1. Depends on how the vein was taken

2. Depends on how it was clinically manifest and whether important signs were missed since an edematous leg is seen in 100% of legs if vein is harvested with open technique.

3. Is a compartment syndrome an accepted risk? It can be, but failure to diagnose it if clinically evident is below the SOC. – Dr RB