Acute compartment syndrome is a rare, but potentially life-threatening risk of brachioplasty (arm-lift) surgery. Mainly affecting the forearm, major signs include pain and swelling of the affected muscles. Acute compartment syndrome requires immediate attention and is treatable through surgery.
Are you tired of the loose skin and excess fat hanging under your forearm after your significant weight loss? Your solution might be a brachioplasty (arm lift) surgery. After performing arm lift surgery for over 15 years, I can attest to the fact that it effectively addresses skin laxity in the forearms.
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Like any major surgery, however, brachioplasty has risks, such as uncomfortable swelling, severe bleeding, and asymmetry. The most concerning, although rare, complication is acute compartment syndrome.
Acute compartment syndrome can be a potentially life-threatening condition if left untreated. Therefore, I advise you to seek immediate medical attention to avoid serious ramifications if you show signs of this syndrome. During our consultation session, I will discuss the important facts about acute compartment syndrome in detail, but I’ve put together this guide to help keep you aware of the symptoms.
What Is Brachioplasty?
Brachioplasty, or arm surgery, is a reconstructive surgical procedure that addresses loose skin and excess fat on the upper arms (generally, between the armpit and the elbow). This procedure is ideal if you’ve undergone significant weight loss and wish to resolve skin laxity.
As your FRACS surgeon, I advise waiting for several months after your significant weight loss to allow your skin to attempt retracting naturally. If there are no signs of the skin contracting to fit the smaller arms, it’s time to book a consultative session where we’ll plan your Brachioplasty. While I make every attempt to ensure that every procedure is a complete success with no complications, I believe in complete transparency which is why I wrote this informative article to educate my patients.
What Is Compartment Syndrome?
Compartment syndrome is one of the more severe, though rare, risks of undergoing brachioplasty. It is a condition in which excess pressure begins to build up in the muscle compartments, potentially affecting the surrounding blood vessels and nerves, and restricting blood flow. If left unattended, these vessels and nerves can die.
Compartment syndrome normally affects isolated areas of the body, such as the lower legs or forearms, but, you can also develop chronic compartment syndrome, affecting the hands, thighs, feet, upper arms, and legs.
Acute Compartment Syndrome vs. Exertional Compartment Syndrome
Compartment syndrome is broken down into two types:
- Acute compartment syndrome
- Exertional compartment syndrome
Acute Compartment Syndrome
Acute compartment syndrome, the most severe type, can be a result of surgical procedure complications or crush injuries. Symptoms of acute compartment syndrome manifest immediately, requiring immediate medical attention.
Exertional Compartment Syndrome
A serious condition called exertional compartment syndrome manifests slowly. It is triggered and enhanced by continuous excessive physical activity that builds pressure in the muscle compartment during exercise. The pressure buildup ceases once you stop exercising.
Unlike acute compartment syndrome, this condition does not pose a life-threatening risk, though it can be painful and uncomfortable.
What Causes Acute Compartment Syndrome in The Arm?
A study by the National Library of Medicine shows that, “[a]cute compartment syndrome occurs when there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Acute compartment syndrome is considered a surgical emergency since, without proper treatment, it can lead to ischemia and eventually necrosis. Generally, acute compartment syndrome is considered a clinical diagnosis. However, intracompartmental pressure (ICP) > 30 mmHg can be used as a threshold to aid in diagnosis. However, a single normal ICP reading does not exclude acute compartment syndrome.”
Below is a simplified explanation of what causes compartment syndrome.
Your arm consists of various muscle groups that are separated by thin connective tissues, called fascia. Each fascia layer features a confined space known as a compartment. This compartment contains muscle tissue fibres, blood vessels, and nerves.
Compartment syndrome happens in the arm when any compartment swells. Swelling in this confined space can potentially lead to acute compartment syndrome.
As a result, the fascia, which harbours the swelling compartment, cannot expand. As pressure begins to build, blood vessels, nerve and muscle cells constrict, leading to acute compartment syndrome. The immediate symptom is a sharp pain in the affected muscle compartment.
Top Causes of Acute Compartment Syndrome
Compartment syndrome depends on the following:
- A serious injury to the arm, arm surgery, or crush injuries
- Severely bruised arm muscles
- A break or severe injury to the bones in the affected limb or limbs
- An arm cast, bandage, or tourniquet that is too tight
- Loss of blood supply in the arms due to positioning during surgery
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Can Brachioplasty (Arm Lift) Cause Compartment Syndrome?
Rarely, an arm lift (brachioplasty) can cause compartment syndrome. The chances of developing compartment syndrome after brachioplasty depend on a variety of factors, including the way the body is positioned during surgery, length of the operation, and the technique used.
If the surgeon removes too much skin and forcefully closes the incision, the muscle compartment restricts. This can also happen when the procedure takes longer than anticipated, which can happen for multiple reasons. In this case, swelling may occur during the surgery, making it challenging to close the incision, causing a forceful closure.
The bottom line is that a forceful incision closure during an arm lift surgery increases the chances of developing compartment syndrome.
How Common Is Acute Compartment Syndrome After an Arm Lift Procedure?
A study by the National Library of Medicine shows that, “[t]he development of a compartment syndrome is based on rising pressure in a defined compartment. Patient positioning is a critical step in any surgical procedure. Inadequate positioning can lead to soft tissue damage and to the development of compartment syndrome.
Resulting from decreased perfusion in well-defined physiological space, Acute Compartment Syndrome is associated with increased compartment pressure. Risk factors include prolonged direct pressure of the affected compartment, venous obstruction, insufficient perfusion, inappropriate fluid accumulation, and coagulopathy. One of the most important risk factors however is the prolonged duration of the procedure.”
To avoid the conditions that lead to compartment syndrome, I advise choosing an expert, experienced, and knowledgeable FRACS surgeon to perform this procedure. I’ve performed body contouring surgery for over 15 years and am happy to report that not a single one of my Brachioplasty patients has ever developed acute compartment syndrome.
Compartment Syndrome Symptoms
Symptoms of acute compartment syndrome after upper arm surgery include:
- Pale skin in the affected area
- Swelling that is so severe that it limits your ability to move your arm
- Intense pain that doesn’t improve with prescribed medication
- Numbness, weakness, loss of sensation, and tingling or burning sensation in the affected arm or hand
- Decreased blood flow
How is Compartment Syndrome Diagnosed?
If you develop acute compartment syndrome symptoms, I urge you to come to see me for an examination to determine whether you are suffering from compartment syndrome.
I will carefully place a needle inside the affected muscle to determine the amount of compartmental pressure. The pressure metre attached to the needle will indicate the extent of pressure buildup in the muscle. If the pressure is too high, I will conduct emergency corrective surgery on the same day to prevent further severe complications. Because it takes just 12 to 24 hours for the pressure buildup to cause nerve or severe muscular damage, timely treatment is of the utmost importance.
Treatment Of Acute Compartment Syndrome
If you suspect that you have compartment syndrome, it’s imperative that you head to the nearest emergency room where a doctor immediately will perform surgery to relieve the compartment pressures.
Is Acute Compartment Syndrome Curable?
If attended to in a timely manner, most patients who seek treatment early have positive outcomes, with nerves and affected muscles repaired and normal limb function restored.
Is Acute Compartment Syndrome Life Threatening?
Yes. Traumatic acute compartment syndrome can be life-threatening if not attended to. The pressure buildup affects vital body organs, including the nerves and blood vessels, which are key in performing body functions.
These complications, if left unattended, escalate quickly, and these critical body organs cease to function in a few hours, resulting in a serious situation. Untreated acute compartment syndrome is extremely painful and generally life-threatening.
A scientific study confirms that, “[a]cute compartment syndrome is both a limb- and life-threatening emergency that requires prompt treatment. To avoid a delay in diagnosis requires vigilance and, if necessary, intercompartmental pressure measurement.”
Another study by National Library of Medicine states “[c]ompartment syndrome is a surgical condition that must be assessed and treated in an urgent manner. Time is of the essence to ensure that ischemic damage is avoided or minimised. There are many reasons behind missed diagnosis, and obtunded or asensate patients are at increased risk.”
What Is Volkmann Ischemic Contracture?
If left untreated, a patient can develop advanced acute compartment syndrome (Volkmann Ischemic Contracture).
Volkmann ischemic contracture is a deformity that affects your fingers, wrist, and hand due to injuries in the forearm muscles. It is the advanced form of acute compartment syndrome.
Compartment pressure buildup constricting the nerves and blood vessels affects blood flow to the fingers, wrist, and lower arm. A prolonged decrease in blood supply causes the muscles in these areas to shorten and become still.
When muscles shorten, they pull from the joints, forming a contracted shape. This shift causes the joint to stay stuck and bent, a common sign of Volkmann ischemic contracture.
Volkmann ischemic contracture has three severity levels. The mild stage occurs when three or more fingers become contracted, losing their feeling senses. During the moderate stage, all fingers contract, and the thumb gets stuck in the palm. The wrist is also bent, and the hand begins losing its feeling senses.
Further nonattendance develops to the severe stage where all forearm muscles responsible for moving and extending the wrist and fingers become affected, disabling the entire hand. There may be minimal finger and arm movement.
Volkmann ischemic contracture is treatable through surgery and specific exercises. For mild and moderate cases, I will conduct corrective surgery to repair the damaged muscles and tendons. However, surgical treatment for severe cases involves removing and replacing severely damaged muscles and tendons.
What to do if you Suspect Acute Compartment Syndrome After Arm Lift (Brachioplasty) Surgery
If you suspect you have acute compartment syndrome, it is a medical emergency, and you must seek immediate medical assistance. After your brachioplasty, I will provide you with my contact information so you can call if you identify any signs or complications.
Time is of the essence for acute compartment syndrome treatment. Hesitation or delays could worsen your condition in the affect limb or limbs, causing permanent damage and requiring amputation.
As you book and come for your appointment, it is best to keep the affected hand slightly above your heart level. Also, loosen any compression garments or bandages that might be too tight.
How to Prevent Acute Compartment Syndrome
I will provide a detailed and personalised post-surgery guide to aid you in your recovery. This guide will include a detailed timeline on when to exercise, what exercises to perform, what to avoid, etc.
But generally, to prevent compartment syndrome after surgery, you should focus on proper care and gradually return to your daily activities. In the first few days, keep your arm elevated and watch for any signs of increased pressure, pain or swelling. I recommend you take prescribed pain medicine to manage pain and discomfort.
As you move into the early recovery phase, begin gentle range-of-motion exercise and light activities like finger movements while avoiding heavy lifting or high-impact actions. Gradually increase the intensity of your exercise, incorporating stretches and strengthening activities specifically for the hand and forearm. Additionally, I advise you to stay hydrated and maintain a balanced diet to support healing.
Other Risk Factors Related to Brachioplasty (Arm Lift) Surgery
Aside from compartment syndrome, here are potential complications that might result from your arm lift surgery:
- Seroma – This is the fluid buildup after surgery.
- Asymmetry – This is when there is a size difference in the arm’s appearance.
- Nerve damage – Nerves might get damaged from the procedure.
- Shoulder and arm stiffness that might be caused by straining the attended arm. Avoid placing your arm above your shoulder level until you recover fully.
- Blood clots
- Chest infections after administration of local anaesthesia.
- Bruising and swelling
Case Report: Woman at 84 Develops Acute Compartment Syndrome Due to a Severe Injury
Here is a case documented by the Orthopaedic Surgery Journal involving a woman suffering from acute compartment syndrome. The woman was checked in the emergency department after complaining of severe pain and discomfort in the upper arm muscles. She had experienced excruciating pain for 24 hours and was unable to move or flex her fingers.
The cause of the chronic compartment syndrome was a minor hit she took to her upper arm. She experienced no pain initially, and the first acute compartment signs began to manifest six days after the hit. The woman described experiencing severe pain and an unusual swelling on the upper arm. She tried pain medication, but the excruciating pain didn’t go away.
Upon admission to the hospital, the doctors attending to her suspected she could be suffering from acute traumatic compartment syndrome. The first response was to make an anterolateral incision during the fasciotomy to relieve pressure buildup.
The surgeon also extracted 200 ml of blood during the fasciotomy, and the corrective surgery concluded with the surgeon closing the skin correctly.
Her recovery began the day after, when she started regaining sensations in her fingers. Later that day, she could flex all affected fingers. Fast-forward three months later, and her arm function was almost back to normal.
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FAQs
Here are some of the most frequently asked questions by most of my clients.
When should I go for an arm lift surgery?
Anyone with loose skin and fat caused by significant weight loss is an ideal candidate for a brachioplasty (arm lift surgery). However, I advise you to maintain a stable weight for about six months, after which you can book a consultation with me to get started.
What causes fat accumulation and flabbiness in my upper arm?
Several factors, such as genetics, age, weight gain, hormonal changes, and lifestyle, can cause fat accumulation in the upper arm. During weight reduction, the skin fails to retract and fully adjust to the changes, causing flabbiness.
What is a full and mini arm lift?
A full arm lift addresses the loose skin in the upper arm and tightens the underlying tissues. Mini arm lifts are less invasive and require smaller incisions. I’ll discuss this and all other brachioplasty options during our consultative session.
Dr. Beldholm’s Final Thoughts
Even though it is a rare complication, chronic compartment syndrome can be uncomfortable, severe, and life-threatening. During our discussion, we will look deeply into how to detect this syndrome in its earliest stages to prevent further severe complications.
References
- Compartment Syndrome. (2022). Penn Medicine.org. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/compartment-syndrome
- Orthop Surg. 2013 Aug; 5(3): 229–232. Published online 2013 Aug 12. doi: 10.1111/os.12054
- Malik, A. A., Khan, W. S. A., Chaudhry, A., Ihsan, M., & Cullen, N. P. (2009). Acute Compartment Syndrome – a Life and Limb Threatening Surgical Emergency. Journal of Perioperative Practice, 19(5), 137–142.
- Du, W., Hu, X., Shen, Y., & Teng, X. (2019). Surgical management of acute compartment syndrome and sequential complications. BMC musculoskeletal disorders, 20(1), 98.
- Donaldson, J., Haddad, B., & Khan, W. S. (2014). The pathophysiology, diagnosis and current management of acute compartment syndrome. The open orthopaedics journal, 8, 185–193.
- Garner, M. R., Taylor, S. A., Gausden, E., & Lyden, J. P. (2014). Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 10(2), 143–152.
- Torlincasi, A. M., Lopez, R. A., & Waseem, M. (2023). Acute Compartment Syndrome.
- Nisi, G., Giardino, F. R., Giudice, M., Fasano, G., Cuomo, R., & Grimaldi, L. (2022). The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures. Journal of clinical medicine, 11(17), 5038.
- Di Pietro, V., Colicchia, G. M., Cervelli, V., & Gentile, P. (2018). Arm Contouring After Massive Weight Loss: Liposuction-Assisted Brachioplasty Versus Standard Technique. Journal of cutaneous and aesthetic surgery, 11(2), 73–78.
- Nagrath, N., & Winters, R. (2023). Brachioplasty.
- Sisti, A., Cuomo, R., Milonia, L., Tassinari, J., Castagna, A., Brandi, C., Grimaldi, L., D’Aniello, C., & Nisi, G. (2018). Complications associated with brachioplasty: a literature review. Acta bio-medica : Atenei Parmensis, 88(4), 393–402.
- Nisi, G., Giardino, F. R., Giudice, M., Fasano, G., Cuomo, R., & Grimaldi, L. (2022). The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures. Journal of clinical medicine, 11(17), 5038.
- Maeckelbergh, L., Colen, S., & Anné, L. (2013b). Upper Arm Compartment Syndrome: A case report and Review of the literature. Orthopaedic Surgery, 5(3), 229–232.
