Delayed Primary Closure of Fasciotomy Incisions in the Lower Leg

Weaver, Michael J.; Owen, Trevor M.; Morgan, Jordan H.; Harris, Mitchel B.

doi:10.1097/bot.0000000000000278

Cited by 30 publications

(16 citation statements)

References 16 publications

(17 reference statements)

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“…[ 22 23 ] Presentation of CS following fracture leads to prolonged LOS and early use of SG for wound closure in contrast to serial repeat debridement to achieve DPC can shorten LOS although the functional and aesthetic results are less satisfying for patients. [ 24 25 ] The observed 8.2% rate of amputation following CS during hospital admission and the high rates of association with male gender and concomitant vascular injury are similar to the 10% rate reported in a meta-analysis study. [ 26 ]…”

Section: Discussionsupporting

confidence: 70%

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lollo

Grabinsky

2016

Int J Crit Illn Inj Sci

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Background:Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy.Methods:Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted.Results:One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work.Conclusion:Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

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Section: Discussionsupporting

confidence: 70%

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lollo

Grabinsky

2016

Int J Crit Illn Inj Sci

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“…In addition, the results of this study may be useful in avoiding unnecessary fasciotomy procedures and fasciotomy wound-related complications, such as impaired sensation around the fasciotomy wound, poor calf muscle function, chronic venous insufficiency, soft tissue and bone infection, amputation, and increased length of hospital stay. 16 – 19 ) In addition, ICP measurements were performed in all ALI patients after revascularization for advocating the diagnosis of CS by clinical criteria, and evaluating the compatibility between clinical criteria and ICP. However, use of a fasciotomy procedure for definitive treatment of CS patients was determined by clinical criteria alone.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Post-Ischemic Compartment Syndrome in Non-Traumatic Acute Limb Ischemia in a Lower Extremity

Orrapin

Arwon

2017

Annals of Vascular Diseases

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Objective: Compartment syndrome (CS) is serious complication following revascularization of acute limb ischemia (ALI). However, predictive factors associated with CS remain unclear. This study aimed to identify these predictive factors.Materials and Methods: Twenty-two patients who presented with non-traumatic ALI between November 2013 and October 2015 were enrolled and monitored for CS in this prospective cohort study. Predictive factors were compared between the CS and non-CS groups.Results: There were 5 patients in the CS group and 17 patients in the non-CS group. Four predictive factors were associated with CS: (1) inadequate backflow (80% and 12% in the CS and non-CS groups, respectively; P=.001); (2) serum creatine kinase (CK) level (20,683 U/L and 911 U/L in the CS and non-CS groups, respectively; P<.001); (3) positive fluid balance after admission (4,324 mL and 1,223 mL in the CS and non-CS groups, respectively; P<.001); and (4) Rutherford category IIB (100% and 18% in the CS and non-CS groups, respectively; P=.0002).Conclusion: Inadequate backflow, high serum CK level, positive fluid balance, and advanced-stage ALI were associated with CS. This information may be useful in identification of high-risk patients for CS prevention and in early detection of CS following the revascularization procedure.

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“…Grafting procedures are often required after fasciotomy with rates of 25%-88% reported in literature [1,4]. Factors associated with significantly diminished likelihood for primary closure and need for grafting include delayed fasciotomies and repeat procedures [16,17]. Weaver et al observed primary closure was unachievable in all fasciotomies requiring >2 irrigation/debridement procedures.…”

Section: Discussionmentioning

confidence: 99%

Closed Incision Negative Pressure Wound Therapy in the Management of a Complex Fasciotomy Wound in a Pediatric Patient

Lee¹,

Murray²,

Hasegawa³

2020

Cureus

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Acute compartment syndrome (ACS) is a known entity that most often occurs in the setting of trauma in both adult and pediatric patients. Fasciotomy remains the gold standard treatment for relieving intracompartmental pressures but is associated with significant complications. Significant variability exists regarding fasciotomy wound management and closure. We present the only known case report on use of circumferentially applied negative pressure wound therapy instill and dwell (NPWTi-d) followed by circumferentially applied closed incision negative pressure wound therapy (ciNPWT) for the soft tissue management of delayed ACS in a pediatric patient.

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Delayed Primary Closure of Fasciotomy Incisions in the Lower Leg

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 30 publications

References 16 publications

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Predictive Factors for Post-Ischemic Compartment Syndrome in Non-Traumatic Acute Limb Ischemia in a Lower Extremity

Closed Incision Negative Pressure Wound Therapy in the Management of a Complex Fasciotomy Wound in a Pediatric Patient

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