FASCIOTOMY IN VASCULAR TRAUMA - IS IT TOO MUCH, TOO OFTEN

Fasciotomy has been used as a prophylactic measure against development of compartment syndrome and as a treatment modality when the syndrome has developed in patients suffering vascular trauma. The hospital rec ords of 36 patients who underwent surgical repair of their traumatic v ascular injuries were reviewed. All 36 patients had at least one indic ation for fasciotomy at the time of repair; i.e., ischemic time of mor e than 6 hours or combined arterial and venous injury. Prophylactic fa sciotomies were performed in 18 of the patients at the time of vascula r repair; 18 did not have fasciotomies performed at the time of initia l repair. The decision to perform a fasciotomy was made by the operati ng surgeon based on well-defined criteria. Hospital stay was significa ntly longer for the fasciotomy group. Four of the fasciotomy-related c omplications were infective in nature. Only one patient who did not un dergo fasciotomy at the time of original repair developed a compartmen t syndrome during the postoperative period. Selective fasciotomy based on well-defined criteria instead of serial physical examinations or m easurement of compartment pressures will effectively save limbs; there is an increased hospital stay.