Time to Wound Closure in Lower Extremity Fasciotomy: A Retrospective and Systematic Review

Area of Science:

• Orthopedics
• Trauma Surgery
• Wound Healing

Background:

• Lower leg compartment syndrome requires fasciotomy for decompression.
• Optimizing wound closure after fasciotomy is crucial for patient outcomes.
• Current literature lacks comprehensive analysis of closure rates based on fasciotomy approach and wound management.

Purpose of the Study:

• To examine wound closure rates in lower leg compartment syndrome based on fasciotomy approach and wound management techniques.
• To compare time to closure and need for skin grafting between different surgical methods and wound care strategies.

Main Methods:

• Retrospective review of 101 adult patients undergoing lower leg fasciotomy (2012-2022).
• Systematic review of PRISMA-guideline-adherent studies on fasciotomy wound closure.
• Analysis of time to closure, skin grafting rates, length of stay (LOS), and injury severity score (ISS).

Main Results:

• Mean time to closure was 9.83 days; single-incision fasciotomy trended towards shorter closure times than dual-incision.
• Wound management techniques showed varied skin grafting needs: VAC (38.2%), shoelace (16.7%), packing (67.6%).
• Delayed closure was significantly associated with increased LOS and ISS, with ISS being the sole independent predictor on multivariate analysis.

Conclusions:

• Trends suggest single-incision fasciotomy may offer faster wound closure for lower leg compartment syndrome.
• Wound management techniques such as wound vac or shoelace closure appear favorable, reducing the need for skin grafting.
• Delayed closure is linked to poorer outcomes, emphasizing the importance of appropriate surgical and wound management strategies.