Abstract
Introduction and objectives
Lower extremity (LE) arterial trauma and its treatment may lead to extremity compartment
syndrome (ECS). In that setting, the decision to perform fasciotomies is multifactoral
and is not well delineated. We evaluated the outcomes of patients with surgically
treated LE arterial injury who underwent early or delayed fasciotomies.
Methods
The National Trauma Data Bank (NTDB) was retrospectively reviewed for patients who
had LE arterial trauma and underwent both open vascular repair and fasciotomies. Exclusion
criteria were additional non-LE vascular trauma, head or spinal cord injuries, crush
injuries, burn injuries, and declaration of death on arrival. Patients were divided
into those who had fasciotomies performed within 8 h (early group) or >8 h after open vascular repair (late group). Comparative analyses of demographics, injury
characteristics, complications, and outcomes were performed.
Results
Of the 1469 patient admissions with lower extremity arterial trauma that met inclusion
criteria there were 612 patients (41.7%) who underwent fasciotomies. There were 543
and 69 patients in the early and late fasciotomy groups, respectively. There was no
significant difference in age, injury severity, mechanism of injury, associated injuries,
and type of vascular repair between the groups. A higher rate of iliac artery injury
was observed in the late fasciotomy group (23.2% vs. 5.9%, P < .001). Patients in the early fasciotomy group had lower amputation rate (8.5% vs.
24.6%, P < .001), lower infection rate (6.6% vs. 14.5%, P = .028) and shorter total hospital stay (18.5 ± 20.7 days vs. 24.2 ± 14.7 days, P = .007) than those in the late fasciotomy group. On multivariable analysis, early fasciotomy
was associated with a 4-fold lower risk of amputation (Odds Ratio 0.26, 95% CI 0.14–0.50,
P < .0001) and 23% shorter hospital LOS (Means Ratio 0.77, 95% CI 0.64–0.94, P = .01).
Conclusion
Early fasciotomy is associated with improved outcomes in patients with lower extremity
vascular trauma treated with surgical intervention. Our findings suggest that appropriate
implementation of early fasciotomy may reduce amputation rates in extremity arterial
injury.
Keywords
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Article info
Publication history
Accepted:
June 3,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
