Illustrated operative management of spontaneous bleeding and compartment syndrome of the lower extremity in a patient with acquired hemophilia A: a case report

Table 1 Course of disease

Day(s) after diagnosis	Clinical symptoms	Laboratory (factor VIII, Bethesda test, activated partial thromboplastin time)	Therapy
0	Compartment syndrome		Minimally invasive lateral fasciotomy
2	Secondary hemorrhage and foot drop (M3, active movement against gravity)		Hematoma evacuation
4	Secondary hemorrhage	Recognition of prolonged activated partial thromboplastin time	Lateral fasciotomy elongation
5	Diagnosis of acquired hemophilia A		Recombinant factor VIIa and corticosteroids
6, 7		3%, 3 Bethesda units, 76 seconds	Vacuum-assisted closure (change)
9, 11	Secondary hemorrhage		Polyvinyl alcohol foam, jetting hose and absorbable dressing
15	Secondary hemorrhage	3%, 8 Bethesda units, 40 seconds	Vacuum-assisted closure polyvinyl alcohol foam, jetting hose and absorbable dressing
17–28		9–33%, 4 Bethesda units, 26–35 seconds	Polyvinyl alcohol foam, jetting hose and absorbable dressing changes
31		41%	Vacuum-assisted closure
35		normal	Vacuum-assisted closure change
43		normal	Split-thickness skin graft
46–106	Delayed wound healing	normal	Open wound therapy with AQUACEL® and Mepitel®
107		normal	Second split-thickness skin graft
108–170	Healed wound	normal	Dismission from traumatologic treatment

ISSN: 1752-1947