Wound closure expectations after fasciotomy for paediatric compartment syndrome

Area of Science:

• Orthopedic Surgery
• Pediatric Surgery
• Trauma Care

Background:

• Acute compartment syndrome frequently necessitates surgical intervention for wound closure.
• Limited data exists on the specifics of wound closure, including surgery numbers, techniques, and complications, in pediatric patients.
• Understanding these factors is crucial for optimizing treatment and patient outcomes in this population.

Purpose of the Study:

• To investigate the number of surgeries, closure techniques, and complications associated with wound closure after acute compartment syndrome in children.
• To analyze factors influencing wound closure and identify common complications in pediatric patients undergoing fasciotomy.

Main Methods:

• Retrospective chart review of pediatric patients treated for acute compartment syndrome over a ten-year period across four hospitals.
• Data collected included cause of injury, dressing type, number of surgeries, closure method, and observed complications.
• Analysis focused on 32 patients who underwent lower (18) and upper (14) extremity fasciotomies.

Main Results:

• Definitive wound closure involved delayed primary closure (72%), split-thickness skin grafts (25%), and primary closure (3%).
• Closure averaged 2.4 surgeries over 7.7 days; these metrics were not significantly impacted by injury cause, fasciotomy site, or dressing type.
• Complications included unfavorable scars (23.1% in upper extremity, 0% in lower), neurapraxia, stiffness, swelling, scar pain, and weakness.

Conclusions:

• Unpleasant scarring is the most frequent complication following pediatric acute compartment syndrome wound closure.
• Approximately 25% of pediatric patients require split-thickness skin grafts for wound closure after upper or lower extremity fasciotomies.
• Cosmetic concerns are more prevalent after upper extremity fasciotomies, even without skin grafting.