Two Urgency Categories, Same Outcome: No Difference After "Therapeutic" vs. "Prophylactic" Fasciotomy

Area of Science:

• Vascular surgery
• Trauma management
• Compartment syndrome treatment

Background:

• Fasciotomy is a critical intervention for managing compartment syndromes in patients with arterial injuries.
• Below-knee fasciotomy is often considered in conjunction with femoropopliteal arterial injury repair.

Purpose of the Study:

• To document the incidence, indications, and outcomes of below-knee fasciotomy in patients with femoropopliteal arterial injuries.
• To compare outcomes between therapeutic and prophylactic fasciotomies and evaluate closure techniques.

Main Methods:

• Utilized the PROspective Observational Vascular Injury Treatment (PROOVIT) registry.
• Identified patients undergoing two-incision, four-compartment fasciotomy post-femoropopliteal arterial repair.
• Compared outcomes based on fasciotomy indication (therapeutic vs. prophylactic) and closure method (primary vs. split-thickness skin graft).

Main Results:

• Fasciotomy was performed in 158 patients, with 95.6% done at the initial operation.
• Among survivors, 58.3% had therapeutic fasciotomy and 41.7% had prophylactic fasciotomy.
• No significant difference in amputation rates between therapeutic and prophylactic groups; primary closure was faster than split-thickness skin grafting (STSG).

Conclusions:

• Over 55% of patients with femoral or popliteal artery injuries undergo concurrent fasciotomy.
• Therapeutic fasciotomy remains more common than prophylactic, but both demonstrate equivalent outcomes.
• Primary skin closure is a more efficient method compared to STSG for fasciotomy wounds.