Chronic Compartment Syndrome Secondary to Advanced Lower Limb Lymphedema: A Case Report

Abstract Chronic compartment syndrome (CCS), though often described in athletes, can occur in patients with long-standing lymphedema due to chronic fibrotic changes in the skin, subcutaneous tissue, and deep fascia. We present a unique case of CCS in a patient with advanced secondary lymphedema of the left lower limb. She underwent multiple sittings of vascularized lymph node transfers and lymphovenous anastomoses. Her final lymph node transfer, combined with bariatric surgery, led to dramatic weight loss and a reduction in lower limb girth. Subsequently, she developed persistent exertional pain and neuropathic symptoms in the left calf, raising suspicion for CCS. Intracompartmental pressure (normal range of 0–10 mm Hg) analysis by manometry confirmed CCS with preoperative readings of 22, 25.2, 17.9, and 29.5 mm Hg in anterior, lateral, superficial, and deep compartments of the leg. Surgical decompression and debulking resulted in postdecompression pressures of 6.5, 6, 4.6, and 4.6 mm Hg, respectively, with good symptomatic relief. This case emphasizes the importance of considering CCS in chronic lymphedema with limb pain and neuropathy unexplained by surgical outcomes.