Long-term sequelae of fasciotomy wounds

doi:10.1054/bjps.2000.3444

British Journal of Plastic Surgery

Volume 53, Issue 8, December 2000, Pages 690-693

https://doi.org/10.1054/bjps.2000.3444 Get rights and content

Summary

A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

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A Rare Case of Monomicrobial Necrotizing Fasciitis Associated With an Initial Acute Compartment Syndrome
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In this article we report a rare case of necrotizing fasciitis presenting with the possible initial symptom of compartment syndrome. After treatment with broad spectrum and targeted antibiotics in addition to multiple fasciotomies, surgical debridement, and grafts the patient went on to uneventful healing within 6 months. This case report highlights the possibility of a compartment syndrome as the only initial symptom of a monomicrobial necrotizing soft tissue infection. While multiple case reports have documented group A streptococcal cellulitis as initiating a later acute compartment syndrome, this is to our knowledge the first case in the foot and ankle of compartment syndrome as a possible early symptom of a group A streptococcal (monomicrobial) necrotizing fasciitis.
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Citation Excerpt :
Wound closure practices vary by case; however, most often the fascia is left open to prevent recurrence [1]. The most frequent sequalae associated with fasciotomy following ACS are neurologic deficits, dry skin and pruritis [1,4]. Muscle herniation in the leg occurs at fascial defects and often presents as chronic leg pain and neuropathy [5].
Acute compartment syndrome (ACS) of the lower extremity is a surgical emergency, often secondary to severe crush injury, and requires immediate fascial release. In treatment of ACS, the underlying fascia is left unrepaired and the subsequent fascial defect does not generally cause negative consequences. Here, we present a 24-year-old man who developed symptomatic muscle herniation 3-years after undergoing fascial release secondary to ACS of the anterior thigh. Given the size of the defect, reconstruction was performed using Acellular Dermal Matrix (ADM). The patient did well, with no complications 6 months postoperatively. Symptomatic muscle herniation following fasciotomy can be treated with hernia reduction and fascial repair. When primary closure is not possible, Acelluar Dermal Matrix (ADM) is an option for successful fascial reconstruction.
Management of extremity fasciotomy sites prospective randomized evaluation of two techniques
2018, American Journal of Surgery
Citation Excerpt :
Early complications include soft tissue infections, osteomyelitis, pain, and deep venous thrombosis related to immobility.2 In addition, long term sequelae have been described including increased limb circumference, reduced range of motion, paresthesias, reduced muscle strength, chronic pain, pruritis, contractures, ulceration, edema, muscle herniation, discoloration, and general discontent with the injured limb.2–7 If altered sensation is included, these sequelae affect up to 95% of all patients, and even with the exclusion of paresthesias and anesthesias, 81% of fasciotomies have long-term complications.4
Morbidity from the treatment of extremity compartment syndrome is underappreciated. Closure technique effectiveness has yet to be definitively established.
A randomized non-blinded prospective study was performed involving patients who underwent an extremity fasciotomy following trauma. Shoelace wounds were strapped with vessel loops under tension and VAC wounds were treated with a standard KCI VAC dressing. After randomization, patients returned to the OR every 96 h until primarily closed or skin grafted.
21 patients were consented for randomization with 11 (52%) successfully closed at the first re-operation. After interim analysis the study was closed early with 5/5 (100%) of wounds treated with the shoelace technique closed primarily and only 1/9 (11%) of VAC wounds closed primarily (p = 0.003). Overall primary closure was achieved in 74% of patients.
Aggressive attempts at wound closure lead to an increased early closure rate. For wounds that remain open after the first re-operation, a simple shoelace technique is more successful than a wound VAC for achieving same hospital stay skin closure.

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Long-term sequelae of fasciotomy wounds

Summary

Orthop Clin North Am

The wick catheter technique for measurement of intramuscular pressure

J Bone Joint Surg

Transfibular route for fasciotomy of the leg

J Bone Joint Surg

Compartmental syndromes

Surg Gynecol Obstet

Compartment syndrome: a potential cause of amputation in battlefield vascular injuries

Int Surg

A report by the British Orthopaedic Association/British Association of Plastic Surgeons Working Party on the management of open tibial fractures

Br J Plast Surg

The relief of traumatic arterial spasm in threatened Volkmann's ischaemic contracture

J Bone Joint Surg

The changing treatment of Volkmann's ischemic contractures from 1955 to 1965 at the Mayo Clinic

Clin Orthop