A young man presented with severe symptoms and markedly elevated hand compartment pressures 5 weeks after undergoing successful decompressive fasciotomies for acute compartment syndrome. The patient's initial postoperative course was complicated by reflex sympathetic dystrophy (RSD). It is hypothesized that the vasomotor instability and the periodic vasospastic episodes associated with RSD prompted postischemic swelling and edema and led to the development of this unusual complication.