Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
Operative wound photograph acquired during repeat operating-room wound exploration, showing an open fasciotomy wound with dusky-to-black necrotic tissue and nonviable-appearing muscle beneath viable skin margins. • TEACHING IMAGE
Fever and Necrotic Tissue Two Days After Extremity Fasciotomy
SCENARIO
A 34-year-old patient sustains a high-energy crush injury to the lower leg. After examination confirms acute compartment syndrome, emergent four-compartment fasciotomy is performed. The wounds are left open, and the patient initially stabilizes. Forty-eight hours later, the patient develops fever to 39.1°C, worsening leukocytosis, increasing pain and malodor from the fasciotomy wound, and tissue discoloration. The patient remains sufficiently stable for immediate transfer to the operating room. The wound is taken for urgent repeat exploration, and the operative image becomes available after exploration begins.