Step 1: Is there evidence of a compartment syndrome?
(1) Diagnostic tests may include direct measurement of compartment pressure or MRI.
(2) Patients with evidence of a compartment syndrome should undergo fasciotomy.
Step 2 - Support and stabilize patient:
(1) Observe and provide hemodynamic support.
(2) Provide silvadene dressing changes to involved regions BID.
Step 3 - Tissue management:
(1) Perform serial debridements in the operating room.
(2) Preserve all questionable tissue for a second look. This helps maximize soft tissue available for reconstruction.
(3) Assess tissue requirements.
Step 4 - Perform definitive surgeries once demarcation complete:
(1) Avoid amputation whenever useful function of an affected limb can be preserved.
(2) Maximize the length on gangrenous limbs. Any tibial length should be preserved in a growing child.
(3) Spare joints whenever possible.
(4) Cover vascularized areas with skin grafts.
(5) Cover exposed bone and joints with microvascular free tissue transfer.
