Chief Vascular Surgery State University of New York Syracuse, New York
Objectives: Acute lower leg compartment syndrome can result in limb loss after emergency revascularization procedures. Although a fasciotomy can relieve intra-compartmental pressure, not all patients achieve a full functional recovery. Factors that affect outcome after emergency fasciotomy remain unclear. We reviewed the functional outcome of a large group of patients who had lower leg fasciotomies after revascularization for limb ischemia.
Methods: A retrospective chart review included all patients treated with fasciotomies at a large Level 1 trauma center between April 2016 and February 2021. The following clinical data was extracted: patient demographics, length of hospital stay, type of ischemia, immediate vs. delayed fasciotomy, wound management, amputation, readmission and/or complications, and functional status at last clinical follow-up. Immediate fasciotomy was defined as being performed during the same surgery as the revascularization. Delayed fasciotomy was performed at a separate surgery after the initial revascularization. Statistical analysis was performed using SPSS version 25.
Results: Fasciotomy after revascularization was performed in 72 patients with follow-up data obtained for 70 patients. Clinical data and demographics are listed in Table I. During short term follow-up, 50% of trauma patients had a full functional recovery compared to 19% of occlusive patients (p=0.015) (Table II). Compared to patients with an immediate fasciotomy, patients with a delayed fasciotomy had more amputations (26% vs 17%) and fewer full recoveries (21% vs 30%) (Table III), however, these differences did not reach statistical significance.
Conclusions: The majority of patients who have a lower leg fasciotomy do not achieve a full functional recovery during short term follow up. Fasciotomy after revascularization for trauma has a higher rate of full functional recovery rate compared to fasciotomy performed for acute occlusive ischemia. Future work based on these findings may allow clinicians to inform patients of what to expect after fasciotomy and help predict the rehabilitation needs of patients treated for acute limb ischemia.
