Predictors for the need for fasciotomy after arterial vascular trauma of the lower extremity

Kluckner, Michaela; Gratl, Alexandra; Grüber, L.; Frech, Andreas; Gummerer, Maria; Enzmann, Florian; Wipper, Sabine; Klocker, Josef

doi:10.1016/j.injury.2021.05.044

Cited by 7 publications

(3 citation statements)

References 23 publications

(16 reference statements)

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“…Aiming to prevent irreversible muscle damage, medial and/or lateral incision of the fascia of the four anatomical compartments of the calf muscles is performed. The most important risk factor for the development of compartment syndrome following ischemia is the time until revascularization is achieved [ 28 ]. Despite this, primary fasciotomy is still controversial, as the procedure itself is associated with the need for re-interventions, until definite wound closure is achieved.…”

Section: Discussionmentioning

confidence: 99%

The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

Gratl

Kluckner

Grüber

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Vascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS). Methods In this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS. Results A total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p < 0.01) in those patients. MESS did not predict delayed amputation within our patient cohort (MESS 8.4 ± 4.1 in the amputation group vs. 8.1 ± 3.8 in the limb salvage group; p = 0.765). Conclusion Revascularization of limbs with isolated popliteal artery injuries should always be attempted. MESS did not predict delayed amputation in our cohort with fasciotomy being an important measure to increase limb salvage rates.

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Section: Discussionmentioning

confidence: 99%

The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

Gratl

Kluckner

Grüber

et al. 2022

Eur J Trauma Emerg Surg

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“…Nghiên cứu của Kluckner cũng cho rằng bệnh nhân của nhóm có mở cân cẳng chân có phân độ Rutherford cao hơn (độ III 34,1% so với 9,7%, p = 0,005) nhóm không mở cân, phân độ Rutherford IIa trở lên là một trong những yếu tố dự báo cho việc cần mở cân cẳng chân trong thiếu máu chi cấp tính. 5 Vị trí tổn thương mạch chủ yếu là động mạch khoeo chiếm 88,6% (Bảng 3). Kết quả này cũng được minh chứng qua nghiên cứu của Đ.Q.Hưng (2017), trong CT-VT mạch máu chi dưới, động mạch khoeo chiếm tỷ lệ cao nhất 175/ 306.…”

Section: Discussionunclassified

Fasciotomy in the treatment of acute lower extremity ischemia due to trauma, vascular wounds at Viet Duc University Hospital

Quoc¹,

Ngoc²,

Hung³

2023

VJCTS

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Objective: The predominant groups of fasciotomy in the treatment of acute lower extremity ischemia due to trauma, vascular wounds at Viet Duc University Hospital. Methods: A retrospective, descriptive, non-control study on patients with a diagnosis of acute lower extremity ischemia who underwent revascularization with leg fasciotomy at Viet Duc University Hospital in the period from January 2020 to December 2021. Results: In 70 studied patients, the male/female ratio = 1.8/1; mean age was 33.2 ± 13.2 years old. Vessels damaged by trauma accounted for 94.3%, wounds accounted for 5.7%; mainly popliteal artery accounted for 88.6%. 75.7% of patients had associated lower extremity fractures or dislocations. Rutherford acute limb ischemia grade IIa or higher accounts for 95.7%. 100% of patients were revascularized at >6 hours from the time of the accident. All patients were able to open the leg fascia right at the beginning; 74.3% performed by a team of orthopedic surgeons; 98.6% of leg fasciotomies were 2 incisions for 4 compartments. The average time of fasciotomy’s closure was 13.84 ± 6.445 days, the earliest was 4 days, the latest was 31 days. After 1 month of discharge, 82.4% of patients limited movement of the limbs; 48.5% of patients did not feel pain in the extremities after surgery. After 6 months, 33.8% of the patients had limited limb movement, 97.1% did not feel pain in the extremities. Conclusion: Leg fasciotomy in the treatment of acute lower extremity ischemia due to trauma or injury is performed, in which, the duration of limb ischemia > 6 hours, popliteal artery injury and the acute limb ischemia classification according to Rutherford from IIa are the predominant groups.

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“…The rate of fasciotomy decompression in patients with peripheral vascular injuries is approximately 20.9–28%. Popliteal vascular injury patients have a particularly high treatment rate of 73.9% for fasciotomy decompression [ 28 – 30 ]. Among these patients, the amputation rate can be as high as 14% [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

A practical nomogram for predicting amputation rates in acute compartment syndrome patients based on clinical factors and biochemical blood markers

Wei

Jiang

Huang

et al. 2023

BMC Musculoskelet Disord

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Background Amputation is a serious complication of acute compartment syndrome (ACS), and predicting the risk factors associated with amputation remains a challenge for surgeons. The aim of this study was to analyze the risk factors for amputation in patients with ACS and develop a nomogram to predict amputation risk more accurately. Methods The study population consisted of 143 patients (32 in the amputation group and 111 in the limb preservation group) diagnosed with ACS. LASSO and multivariate logistic regression were used to screen predictors and create a nomogram. The model’s accuracy was assessed by receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA). Results The predictors included cause of injury, vascular damage, shock, and fibrinogen in the nomogram. The C-index of the model was 0.872 (95% confidence interval: 0.854–0.962), and the C-index calculated by internal validation was 0.838. The nomogram’s area under the curve (AUC) was 0.849, and the calibration curve demonstrated a high degree of agreement between the nomogram’s predictions and actual observations. Additionally, the DCA indicated good clinical utility for the nomogram. Conclusion The risk of amputation in ACS patients is associated with the cause of injury, vascular damage, shock, and fibrinogen. Our nomogram integrating clinical factors and biochemical blood markers enables doctors to more conveniently predict the risk of amputation in patients with ACS.

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Predictors for the need for fasciotomy after arterial vascular trauma of the lower extremity

Cited by 7 publications

References 23 publications

The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury

Fasciotomy in the treatment of acute lower extremity ischemia due to trauma, vascular wounds at Viet Duc University Hospital

A practical nomogram for predicting amputation rates in acute compartment syndrome patients based on clinical factors and biochemical blood markers

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