Factors associated with persistent sequelae after fasciotomy for acute compartment syndrome

To determine factors associated with persistent sequelae after fasciotomy for acute compartment syndrome.

Records of 57 men and 3 women aged 8 to 84 (mean, 31.9) years who underwent fasciotomy of the lower (n=48) or upper (n=12) limbs for acute compartment syndrome following limb trauma were retrospectively reviewed. 58 of the fasciotomies were therapeutic and 2 were prophylactic. The mean follow-up was 3.9 (range, 1-8) years. Patients were assessed through a telephone survey for persistent sequelae (parasthaesia, dysasthaesia, and/or motor weakness), using a scale of one to 4 to indicate asymptomatic, mild, moderate, and severe, respectively. Associations of persistent sequelae with the aetiology, mechanism of injury, site of fasciotomy, time to fasciotomy (from admission to anaesthesia induction), number of operations, method of closure, time to closure, and perioperative complications were assessed.

18 patients were asymptomatic and 42 reported having persistent sequelae including motor weakness (n=26), parasthaesia (n=28), and dysasthaesia (n=30). In terms of severity, these sequelae were mild (n=10), moderate (n=12), or severe (n=20). Persistent sequelae were associated with higher number of operations, post-fasciotomy complications, closures with skin grafting, and increased time to closure.

To reduce the risk of persistent sequelae after fasciotomy, careful preoperative planning and meticulous perioperative care is needed to avoid multiple operations and post-fasciotomy complications. Patients whose wounds healed by secondary intention showed the best outcome.