Reconstruction of COVID-19–Related Compartment Syndrome With Massive Soft Tissue Necrosis

Christopher Bibbo, DO, FACS, FAAOS, FACFAS


Wounds. 2021;33(4):99-105. 

In This Article


Fulminant respiratory failure with alveolar leak can result from COVID-19. Coagulopathies also develop in large numbers of patients. These 2 pathologic processes may have serious systemic implications, such as thrombosis or hemorrhage, resulting in dysfunction of multiple organ systems. The combination of a systemic capillary leak syndrome, coupled with a thrombotic/hemorrhagic coagulopathy ("triple hit") may also impart serious complications, such as compartment syndrome of the extremities. Although infrequently reported, vigilance must be employed with a high level of suspicion for compartment syndrome in patients with COVID-19 infection who develop tense limb edema and soft tissue changes, such as blisters and discolored bullae. In the obtunded patient, there must be a low threshold to evaluate for compartment syndrome of an extremity. In order to achieve limb salvage, surgical intervention should be performed as soon as the patient is rendered physiologically stable to tolerate an operative setting. The timing of reconstruction of the sequelae of compartment syndrome in the patient who is acutely ill is challenging, but optimal timing can result in a successful outcome.