Mechanisms:
(1) overconstriction
(2) tissue swelling with expansion
Potential causes:
(1) cast or wound dressing that is too tight
(2) fascial closure that is too tight
(3) tissue edema secondary to the injury
(4) hemorrhage from a leaking blood vessel
(5) bleeding associated with anticoagulation or a coagulopathy
(6) extravasation from an infusion
(7) proximal venous thrombosis
Management:
(1) Make sure that any cast or dressing is not too tight.
(2) Keep the limb elevated (to reduce passive accumulation of fluid).
(3) Make sure that good hemostasis has been achieved prior to closure.
(4) Inspect the limb frequently, looking for signs of swelling or poor perfusion.
(5) Check the pulses distally.
(6) Check with the patient about any pain, numbness or tingling in the limb.
Barriers to care:
(1) an unconscious or sedated patient may not be able to report symptoms
(2) failure of the healthcare team to evaluate the limb
(3) outpatient discharged home
(4) failure to identify all of the problems that are present
