Upper-Extremity Phlegmasia Cerulea Dolens With Compartment Syndrome in Coronavirus Disease 2019 Sepsis

Hembd, Austin; Kim, Hannah; Lahsaei, Peiman; Haddock, Nicholas T.; Teotia, Sumeet S.

doi:10.1016/j.jhsa.2021.04.028

Cited by 5 publications

(10 citation statements)

References 11 publications

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“…Although our study focused on overall limb survival, successful (though temporary) limb salvage following fasciotomy was reported in one patient who later died during the course of their hospital stay. 5 Because it is impossible to predict survival outcomes, limb salvage should be strongly considered when the risks of doing so do not prioritize limb over life. One should also consider that emergent fasciotomy in this setting does not guarantee limb salvage.…”

Section: Discussionmentioning

confidence: 99%

Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure?

Holzmer

Walsh

Mohiuddin

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Based on the findings of two consecutive cases of upper extremity compartment syndrome encountered at our institution, we hypothesize that the presence of compartment syndrome in the unstable COVID-19 patient may be associated with high mortality and low limb salvage rates. A literature search was conducted with key search terms, including “compartment syndrome, fasciotomy, COVID, and coronavirus.” Articles describing patients with a confirmed COVID-19 diagnosis who developed extremity compartment syndrome were included in our study. The primary outcome investigated was patient survival. Secondary outcomes included limb survival and limb salvage. Limb salvage was calculated in patients who survived to time of discharge, whereas limb survival was counted for all patients. We then added our two cases to the findings reported in our literature to determine current overall limb salvage and patient survival rates. Our review of the literature yielded six case reports of ten extremities that developed compartment syndrome in the COVID-19 positive patient. Overall survival was four of six patients (67%). The overall limb survival rate at the time of hospital discharge was three of 10 (30%). With the addition of our two cases, overall survival was four of eight (50%) and overall limb survival rate was three of 12 (25%). Furthermore, with inclusion of our two cases, the patient survival rate of hemodynamically unstable patients was only three of seven (43%). The development of compartment syndrome in the unstable COVID-19 patient may be a harbinger of death, and the decision to proceed with operative intervention is challenging, complex, and in some cases must prioritize life over limb.

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Section: Discussionmentioning

confidence: 99%

Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure?

Holzmer

Walsh

Mohiuddin

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Cases of limb ischemia related to COVID-19–induced arterial thrombi and deep venous thrombosis have been reported. 7 A case of upper-extremity compartment syndrome, specifically, associated with acute superficial venous thrombosis in the setting of severe COVID-19 infection, highlights the potential of hypercoagulable state–induced compartment syndrome related to infection. 7 One case of acute compartment syndrome of the hand was reported by Hill et al 8 in a patient with COVID-19 with acute respiratory distress syndrome on anticoagulation after extravasation around an arterial line site.…”

Section: Discussionmentioning

confidence: 99%

Isolated Compartment Syndrome of the Hand After Intravenous Doxycycline Infiltration Injury

Tirrell

Nigam

Hung

2022

Journal of Hand Surgery Global Online

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Isolated compartment syndrome of the hand, although uncommon, can lead to considerable functional deficits if not treated promptly. The most common etiologies are related to trauma, burns, or electric injuries; however, some cases have been reported after intravenous infiltration events, particularly rapid intravenous contrast injection. In this case report, we describe the development of compartment syndrome in the hand of a critically ill patient with COVID-19 pneumonia and sepsis 16 days after doxycycline infiltration injury. She presented with worsening pain, swelling, bullous eruption, and intrinsic minus hand posturing. Emergent surgical release of intrinsic hand compartments and evacuation of a hematoma resolved her symptoms and preserved hand function. Early recognition and surgical intervention of compartment syndrome of the hand after infiltration injury in medically complex patients will reduce morbidity in this patient population.

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“…Hembd et al. publizierten den Kasus einer Patientin, die an einer Chemotherapie assoziierten Thrombozytopenie litt und im Rahmen einer COVID-19-Sepsis eine PCD der oberen Extremität entwickelte [ 9 ].…”

Section: Diskussionunclassified

“…Dieser geschilderte Fall stützt die neueren Erkenntnisse, dass die Anwendung einer aggressiven therapeutischen Antikoagulation bei Patienten mit schwerer COVID-19-Infektion einen Vorteil gegenüber einer prophylaktischen Antikoagulation bietet [ 9 – 11 ].…”

Section: Diskussionunclassified