Compartment Syndrome in the Fibula Flap Donor Site: A Case Report and Review of the Literature.

Compartment syndrome (CS) is a rare but serious complication following fibula flap harvest. We report a 72-year-old man who developed donor-site CS on postoperative day 3 without pain but with edema, blisters, and paresthesia. Serum creatine phosphokinase rose to 17,677 IU/L, indicating its diagnostic utility. Immediate wound release, debridement, negative pressure therapy, and skin grafting achieved sensory and motor recovery with independent ambulation at 9 months. Review of eight previous cases showed a mean skin paddle width of 4.16 (3-5) cm. Seven donor sites were primarily closed under tight or slightly tight tension, and one was left open. The mean onset was postoperative day 5.62 (0-14). Clinical manifestations were dominated by cutaneous or motor changes, while pain was uncommon. CS may occur irrespective of skin paddle width and without pain, delaying recognition. Vigilant monitoring for cutaneous or neurologic signs and early intervention are essential to minimize sequelae.