Predictors for surgical site infection after fasciotomy in patients with acute leg compartment syndrome

Yang, Shuo; Long, Yubin; Wang, Tao; Guo, Junfei; Hou, Zhiyong

doi:10.1186/s13018-023-03589-9

Cited by 12 publications

(17 citation statements)

References 48 publications

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“…As orthopedists turn out to be more aware of NPWT, they extended the use in numerous surgical procedures, for example, it is now being used as a postoperative dressing for fasciotomy wounds after compartment release. 6 Latest studies have reported the usefulness of the application of prophylactic NPWT on closed incisions after high-energy lower extremity trauma and total joint arthroplasty. 4,7 These positive outcomes recommend that NPWT might be an adjunct to decrease wound problems for primarily closed incisions in OTS, nonetheless, no clear consensus was accomplished depending on the existing studies.…”

Section: Introductionmentioning

confidence: 99%

“…It was used effectively in open wound treatment and wound problems after orthopaedic surgery. As orthopedists turn out to be more aware of NPWT, they extended the use in numerous surgical procedures, for example, it is now being used as a postoperative dressing for fasciotomy wounds after compartment release 6 . Latest studies have reported the usefulness of the application of prophylactic NPWT on closed incisions after high‐energy lower extremity trauma and total joint arthroplasty 4,7 …”

Section: Introductionmentioning

confidence: 99%

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A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

Zhang

2022

International Wound Journal

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We performed a meta‐analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed‐effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48‐0.87, P = .004), superficial SSIs (OR, 0.34; 95% CI, 0.19‐0.61, P < .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21‐0.80, P = .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

Zhang

2022

International Wound Journal

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“…26 A separate matched cohort study showed markedly shorter times to definitive closure for bilateral leg fasciotomy wounds treated with NPWT compared with dressing changes. 27…”

Section: Adjunct Options For Fasciotomy Closurementioning

confidence: 99%

“…26 A separate matched cohort study showed markedly shorter times to definitive closure for bilateral leg fasciotomy wounds treated with NPWT compared with dressing changes. 27 NPWT has also proven useful in contaminated wounds, specifically as an incisional, or "closed," system. 28 Although the results of this prospective, randomized, controlled trial are inspiring, infectious and traumatic contaminated fasciotomy wounds, as previously mentioned, are rarely fit for early primary closure.…”

Section: Adjunct Options For Fasciotomy Closure Negative Pressure Wou...mentioning

confidence: 99%

Principles of Fasciotomy Closure After Compartment Syndrome Release

Sraj

Henderson

Bramer

et al. 2022

J Am Acad Orthop Surg

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Acute compartment syndrome is a surgical emergency in the extremities resulting from increased compartmental pressure, requiring immediate fasciotomy to resolve muscular compromise. As the mainstay treatment, fasciotomies involve substantial skin incisions and are thus prone to complications such as skin necrosis, wound infection, and permanent disability. Multidisciplinary care instituted at the time of fasciotomy can facilitate timely closure and minimize the complication profile. Several approaches are available to enhance outcomes of fasciotomy wounds, and a comprehensive knowledge of these options affords the treating surgeon greater flexibility and confidence in optimal management. Common techniques include early primary closure, gradual approximation, skin grafting, and negative pressure therapy. There is currently no consensus on the best method of closure. The purpose of this study was to review fasciotomy wound management from the time of initial release to final closure. Highlights include preparation for closing these wounds; the various techniques for fasciotomy closure, including adjunct options; evaluation of timing and staging; and injury-specific features, such as fracture management, limited subcutaneous tissues, and hand fasciotomies. Combining the perspectives of orthopaedic and plastic surgery, this review evaluates the benefits of multiple closure methods and highlights the importance of planning closure at the time of release.

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“…Most publications on VAC therapy focus on wound conditioning through wound cleaning, generation of granulation tissue, induction of neo-angiogenesis, approximation of wound margins, and reduction of interstitial edema. 1,2,5–10 In addition, some reports discuss the use of VAC therapy to fix split-thickness skin grafts on free muscle flaps. 11–17…”

Section: Introductionmentioning

confidence: 99%

Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study

Kuenlen

Waked

Eisenburger

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background:The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps. Methods: In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro-and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation. Results: The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group. Conclusions: VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient's safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.

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Predictors for surgical site infection after fasciotomy in patients with acute leg compartment syndrome

Cited by 12 publications

References 48 publications

A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

Principles of Fasciotomy Closure After Compartment Syndrome Release

Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study

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