Long-term sequelae of fasciotomy wounds

Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk

“…Fitzgerald at al detailed wound complications following closure including painful scars, altered sensation, dry scaly skin, pruritus, wound discoloration, swollen limbs, tethered scars, recurrent ulceration, muscle herniation, and tethered tendons. These side effects led to patients keeping their wound covered, changing hobbies, and even changing occupation [46]. Lower extremity fasciotomies, underlying vascular injuries, prophylactic fasciotomies, and an elapsed time from injury to fasciotomy greater than eight hours all lead to increased wound complication rates.…”

Lower Limb Acute Compartment Syndrome After Colorectal Surgery in Prolonged Lithotomy Position

“…Fasciotomies themselves are associated with a high incidence of acute complications (nerve damage in 15 percent of cases; bleeding in 35 percent; wound infection in 25 percent) and long-term (altered sensation in 95 percent; continuing pain in 55 percent; eczematous changes in 40 percent; pruritus in 33 percent; discoloration in 30 percent; recurrent ulceration in 13 percent). 41,42 Hyperbaric oxygen may be used as adjunct to fasciotomy, because it reduces edema and muscle necrosis as a result of an arteriolar vasoconstrictor effect and an increase of tissue oxygen tension, allows better wound healing, reduces need for repetitive surgery, and acts against infection 43,44 but is not a generally available technique.…”

Geographic variation in fasciotomy during operative management of tibia fractures

“…A missed or delayed diagnosis potentially results in deleterious consequences such as ischemic contracture, neurological sequelae, infection and ultimately amputation. 5 Alternatively, unnecessary fasciotomy carries noted morbidity. Patients who have undergone an open fasciotomy can develop complications of residual pain, altered sensation, wound morbidity and long-term functional deficit.…”

“…Patients who have undergone an open fasciotomy can develop complications of residual pain, altered sensation, wound morbidity and long-term functional deficit. 5 Diagnosis and management of ACS remains challenging for orthopedic surgeons, who must avoid a missed diagnosis, but also minimize the risk of an unnecessary surgical procedure with significant morbidity. Variation in the diagnosis rate of ACS among individual surgeons has been noted and highlights the difficulty of diagnosing compartment syndrome in clinical practice 3 .…”