Compartment Syndrome

[Emgil]

Short version: I tore my plantaras tendon while walking down stairs. Swelling ensued and I saw my doctor 24 hrs after the incident. Referred to a nearby orthopedic surgeon who within 15 seconds identified acute compartment syndrome and sent me for emergency surgery. Six bags of frozen plasma to reverse the anti-coagulation, a reaction to morphine calling for countermedicating, surgery, removal of a soft-ball-size clot and, three days later a skin graft to cover the enormous open wound on my calf. Two weeks in the hospital and now home recovering nicely. The doctor says that if I had not been on anti-coagulation it would have been a non-event. My question: Any similar experience and wise counsel out there regarding how to care for my graft area and how to protect it since I want to resume my typically active work in the yard and bushes and areas that want clearing of brush in the yard? How to guard against any similar future events?
Peace, Love and Rock and Roll (Listening to KPIG right now

 

[Marty]

Sounds like you had expert care. Below the knee compartment syndrome is an emergency. Do you happen to know what yout INR was at the time of the injury or before they gave you the plasma? About two years ago I had a bad tumble and a few hours after that I developed severe pain above the knee in the quadriceps L. leg. The orthopod asked me to get an MRI and then see him. The MRI showed a big bleed in the quad dissecting down below the knee. When he examined me the upper leg was hard as a rock and screaming pain if touched. He told me if he cut into the quad the muscle would come out like a bloody sponge and he would need a big graft to close the wound. He told me to stop warfarin, gave me a big scrip for Percoset, and absolute bed rest. I had been keeping my INR 3.5 to 4( I self test and self prescribe) After about four days I called my cardiologist and he told me start up gingerly and adjust my dose to get an INR around 2.5, no higher thqn 3.0. After two weeks I got so I could walk a little and the leg became softer and less tender though the whole leg colored purple including the foot. I'm fine now and I keep the INR as close to 2.5 as I can; never over 3.0 and try not to fall down.

 

[Emgil]

My INR was 3.6 on arrival at the hospital. My target is 2.5-3.5 so I was running a little rich.

 

[Guest]

A 3.6 with a target of 3.5 is like saying that yow were sppeding by doing 36 in a 35 zone. Technically it is but does it really matter?

When I read this, I was hoping that Marty would respond because he is our resident expert on compartment syndrome. He is a physician and has experienced it also.

 

[Marty]

This is a little bit like the thread where the man died of dog bite. An INR of 3.6 won't usually cause spontaneous bleeding but a man with INR of 3.6 who tears his plantaris muscle below the knee will bleed more than a non warfarin patient and maybe bleed enough into a closed compartment to increase pressure ,shut off blood supply ,and require amputation! Above the knee bleed like mine was painful but not so dangerous.
The quadriceps compartment is bigger and leaks down into the lower leg and foot.