COMPLICATIONS AND NONCLOSURE RATES OF FASCIOTOMY FOR TRAUMA AND RELATED RISK-FACTORS

The objective of this study was to identify risk factors for the devel opment of complications and unsatisfactory skin closure following fasc iotomy for trauma. Risk factors included in the study are prolonged ti me from injury to fasciotomy, type of fasciotomy, site of injury, and kind of underlying injury. The study was a retrospective analysis of 1 00 consecutive fasciotomies done for trauma over a period of 38 months (December 1991 to January 1995) in a ''level 1'' trauma center at a u niversity-affiliated county teaching hospital; Ninety-four patients we re eligible for analysis, 29 of whom (31%) developed complications at the fasciotomy site. The risk was increased for lower extremity versus upper extremity (34.3% versus 20.8%), prophylactic versus therapeutic (42.0% versus 23.6%), late (>8 hours) versus early (37% versus 25%), and vascular versus musculoskeletal (38.8% versus 22.2%) trauma cases. The same risk factors negatively influenced the ability to close the skin primarily. The four subgroups defined by vascular/nonvascular inj ury and upper/lower extremity site had significantly different nonclos ure rates (p = 0.043). The rate. was highest among the vascular/lower extremity group (60.5%) and lowest among the nonvascular/upper extremi ty group (15.4%). We concluded that fasciotomies in lower extremities, the presence of underlying vascular injuries, fasciotomies performed prophylactically, and a time between the injury and fasciotomy of more than 8 hours are associated with an increased risk for local complica tions. The same factors are associated with an increased need for skin grafting the wound.