Acute compartment syndrome: progress and new viewpoints

Acute compartment syndrome (ACS), a serious complication caused by high-energy injury, results in tissue ischemia, myonecrosis, or even amputation. We aim to review significant improvements, including diagnosis, treatment, and outcomes, of ACS in the last 5 years. We searched studies related to ACS from the PubMed, Medline, and Cochrane Library databases using keywords: “acute compartment syndrome,” “history,” “epidemiology,” “diagnosis,” “treatment,” “anesthesia,” “animal models,” and “molecular biology research.” Currently, the diagnostic approach to ACS typically relies on a combination of clinical judgment and intracompartmental pressures (ICP). The role of invasive and non-invasive measurements, such as ultrasound, near-infrared spectroscopy, and serum biomarkers, in diagnosing ACS should be emphasized. While fasciotomy is widely applied to reduce ICP, recent studies have focused on assessing its effectiveness. Recent findings have shown that regional anesthesia could be a remarkably effective and safe approach to pain management, as it can boost blood flow in the extremities via sympathetic blockade for patients at risk of ACS. Knowing about its pathophysiological mechanisms assists us in early diagnosis and effective outcomes. This study mainly summarizes diagnosis, treatments, and biological experiments while highlighting future directions and promising developments in ACS management. Multidisciplinary collaboration is needed in early precise diagnosis and minimally invasive effective treatment, as well as in-depth potential mechanisms.