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To determine the utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome (CS).Nine patients with CS confirmed by physical examination and elevated compartment pressures (64 ± 17 mm Hg) were evaluated before and after fasciotomy. Control readings were also performed on 33 surgical patients who had no evidence of CS. The deltoid muscle was used as a reference value.The deltoid muscle oxygen saturation (StO2) readings revealed a mean = 84 ± 17% prefasciotomy and mean = 83 ± 12% postfasciotomy in the CS group. The control group had a mean StO2 of 83 ± 11%. In the CS group, the leg compartment with the highest pressure had a StO2 mean = 56 ± 27% before fasciotomy. This value was statistically significantly lower (p < 0.05) than either the postfasciotomy mean StO2 in that compartment (82 ± 16%) or the values found in matched control patients with no evidence of CS (87 ± 7%).Near-infrared spectroscopy-derived StO2 values in the lower extremities of trauma patients with CS were diminished relative to the control patients and usually normalized after fasciotomy. Near-infrared spectroscopy evaluation may offer a rapid, noninvasive method of assessing extremities at risk for CS.