shown to be effective in diagnosing chronic exertional compartment syndrome. the average duration of symptoms prior to diagnosis is 28 months. treatment acute use of a skin graft to close a fasciotomy wound. any external compression (tourniquet, orthopedic casts or dressings applied on the affected limb) should be removed. cutting of the cast will reduce the intracompartmental pressure by 65%, followed by 10 to 20% pressure reduction once padding is cut. after removal of the external compression the limb should be placed at the level of the heart. the vital signs of the patient should be closely monitored. if the clinical condition does not improve, then fasciotomy is indicated to decompress the compartments. an incision large enough to decompress all the compartments is necessary. this surgical procedure is performed inside an operating theater under general or local anesthesia. the timing of the fasciotomy wound closure is debated. some surgeons suggest wound closure should be done seven days after fasciotomy. multiple techniques exist for closure of the surgical site including vacuum-assisted and shoelace. both techniques are acceptable methods for closure, but the vacuum-assisted technique has led to longer hospitalization time. a skin graft may be required to close the wound, which would complicate the treatment with a much longer hospitalization stay. chronic treatment for chronic exertional compartment syndrome can include decreasing or subsiding exercise and/or exacerbating activities, massage, non-steroidal anti-inflammatory medication, and physiotherapy. chronic compartment syndrome in the lower leg can be treated conservatively or surgically. conservative treatment includes rest, anti-inflammatory medications, and manual decompression. warming the affected area with a heating pad may help to loosen the fascia prior to exercise. icing the area may result in further constriction of the fascia and is not recommended before or after exercise. the use of devices that apply external pressure to the area, such as splints, casts, and tight wound dressings, should be avoided. if symptoms persist after conservative treatment or if an individual does not wish to give up the physical activities which bring on symptoms, compartment syndrome can be treated by a surgery known as a fasciotomy. a us military study conducted in 2012 found that teaching individuals with lower leg chronic exertional compartment syndrome to change their running style to a forefoot running technique abated symptoms in those with symptoms limited to the anterior compartment. running with a forefoot strike limits use of the tibialis anterior muscle which may explain the relief in symptoms in those with anterior compartment syndrome. hyperbaric oxygen therapy has been suggested by case reports – though as of 2011 not proven in randomized control trials – to be an effective adjunctive therapy for crush injury, compartment syndrome, and other acute traumatic ischemias, by improving wound healing and reducing the need for repetitive surgery. prognosis a mortality rate of 47% has been reported for acute compartment syndrome of the thigh. according to one study the rate of fasciotomy for acute compartment syndrome varied from 2% to 24%. this is due to uncertainty and differences in labeling a condition as acute compartment syndrome. the most significant prognostic factor in people with acute compartment syndrome is time to diagnosis and subsequent fasciotomy. in people with a missed or late diagnosis of acute compartment syndrome, limb amputation may be necessary for survival. following a fasciotomy, some symptoms may be permanent depending on factors such as which compartment, time until fasciotomy, and muscle necrosis. muscle necrosis can occur quickly, within 3 hours of original injury in some studies. fasciotomy of the lateral compartment of the leg may lead to symptoms due to the nerves and muscles in that compartment. these may include foot drop, numbness along leg, numbness of big toe, pain, and loss of foot eversion. epidemiology in one case series of 164 people with acute compartment syndrome, 69% of the cases had an associated fracture. the authors of that article also calculated an annual incidence of acute compartment syndrome of 1 to 7.3 per 100,000. there are significant differences in the incidence of acute compartment syndrome based on age and gender in the setting of trauma. men are ten times more likely than women to develop acs. the mean age for acs in men is 30 years while the mean age is 44 years for women. acute compartment syndrome may occur more often in individuals less than 35 years old due to increased muscle mass within the compartments . the anterior compartment of the leg is the most common site for acs.