Thus, the primary goal in treating this condition is the prompt lowering of tissue pressure to normal levels. A definitive reduction in tissue pressure is accomplished by the complete opening of all envelopes surrounding the affected tissue. This opening must not only decompress the contents of the compartment, but also accommodate any postischemic swelling occurring after the decompression procedure.
Pliable dressings are simply divided down to the level of the skin.
Rigid dressings such as casts should be bivalved so that the anterior half may be completely removed. A single cut through a cast, even if the cast is spread and wedged open, often does not sufficiently increase the volume of the cast envelope. Although removal of the front half of a cast may jeopardize the reduction of a fracture, restoration of local circulation must take precedence. This is true whether the local arterial pressure has been reduced by shock, peripheral vascular disease, or elevation of the limb above the heart. Thus, treatment of systemic hypotension and avoidance of limb elevation are important for the maintenance of local arterial pressure and in the management of compartmental syndromes.