Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

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 hours (Early Group) or > 8 hours after open vascular repair (Late Group). Comparative analyses of demographics, injury characteristics, complications, and outcomes were performed. Results Of the 1,469 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 shorted 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.

Peripheral Arterial Injuries: an Indian Experience

“…Liberal fasciotomy should be applied prophylactically to reduce risk of adverse limb outcomes [24]. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality [22].…”

Successful Late Repair of Popliteal Artery Rupture with Compartment Syndrome

“…Furthermore, fasciotomy needs to be performed to reduce the risk of limb loss and death. 3 Many factors, such as the extent of soft tissue damage, the capacity of collaterals, pre-existing arterial disease, and the ischemia time may affect the clinical outcomes. 6 Mckenzie et al 7 found that the greatest impact on decision making between limb salvage and amputation depend on the severity of soft tissue injury.…”

“…2 In addition, the presence of extremity compartment syndrome in vascular injury is associated with significant morbidity and mortality. 3 Our case was unique since the patient had delayed revascularization for 42 hours with compartment syndrome as a comorbid condition yet successfully underwent arterial repair surgery without serious complication. …”

Competing Priorities in the Brain Injured Patient: Dealing with the Unexpected

“…53 Fasciotomies should be performed in a timely fashion when evidence of elevated compartment pressures is present. 54,55 …”