90-Day Complications After Elective Fasciotomy for Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) causes activity-related pain and neurologic symptoms due to increased intracompartmental pressure during exercise. Fasciotomy is commonly performed when nonoperative treatment fails, but short-term postoperative complications remain poorly characterized. This retrospective cohort study evaluated patients aged ≥14 years who underwent elective open fasciotomy for CECS at a single academic medical center between 2000 and 2024. Demographics, surgical characteristics, postoperative complications, and reoperations within 90 days were recorded. Twenty-eight patients underwent 44 operations involving 56 lower extremities, with a median age of 21 years. Eleven procedures (19.6%) were repeat fasciotomies. Postoperative complications occurred in 17 extremities (30.3%). Infection and/or poor wound healing occurred in 12 (21.4%), including five cases of superficial cellulitis, six superficial abscesses with poor wound healing, and one case of serous drainage. Five extremities (8.9%) developed symptomatic hematomas, one patient (1.8%) developed a deep venous thrombosis, and four (7.1%) experienced temporary nerve-related symptoms without permanent deficit. Five patients required reoperation. Open fasciotomy for CECS was associated with meaningful early postoperative morbidity, although most complications resolved without surgical intervention, emphasizing the importance of preoperative counseling regarding recovery and surgical risks