Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome

Ji Yong Park; Young Chang Kim; Ji Wan Kim

doi:10.12671/jkfs.2015.28.4.223

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Park, Kim, and Kim: Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome

Original Article

Journal of the Korean Fracture Society 2015; 28(4): 223-229.

Published online: 19 October 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.4.223

Clinical Outcomes of Fasciotomy for Acute Compartment Syndrome

Ji Yong Park, M.D., Young Chang Kim, M.D., Ph.D., Ji Wan Kim, M.D., Ph.D.

Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Ji Wan Kim, M.D., Ph.D. Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. Tel: 82-51-797-0668, Fax: 82-51-797-0669, H00106@paik.ac.kr

Received 1 July 2015 Revised 20 July 2015 Accepted 20 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome.

Materials and Methods

Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection.

Results

According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection.

Conclusion

Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.

Keywords: Acute compartment syndrome, Fasciotomy, Wound management, Complications

Figures and Tables

Fig. 1

(A) A 41-year-old male had both a tibia shaft fracture and severe swelling on the left leg with pain. Emergency fasciotomy was performed with a double incision on lateral (B) and medial (C). A photograph at 4 days after injury shows that shoelace technique and negative pressure wound dressing was applied on lateral (D) and medial (E). Progressive wound closure was performed using shoelace technique and negative pressure wound dressing on the lateral side (F) and medial side (G). (H, I) At 16 days after injury, complete wound closure was possible without skin graft.

Table 1

Summary of Clinical Course in 17 Patients

M: Male, F: Female, T: Traumatic, U/C: Uncheckable, AK: Above knee, BK: Below knee, VAC: Vacuum-assisted closure, STSG: Split thickness skin graft.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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