A CRITICAL REAPPRAISAL OF INDICATIONS FOR FASCIOTOMY AFTER EXTREMITY VASCULAR TRAUMA

Objective: To critically reevaluate the indications for fasciotomy in vascular trauma of the extremities. Design: Case-control study. Settin g: Level I trauma center. Materials and Methods: One hundred sixty-thr ee vascular injuries to the extremeties were analyzed. Fasciotomy as a n adjunct to vascular repair was performed in 45 limbs (28%), based ei ther on the nature of injury or measured compartment pressure of great er than 35 mm Hg. Main Outcome Measures: Need for fasciotomy or limb a mputation. Results: Fasciotomy was performed for 29.5% of isolated art erial injuries, 15.2% of isolated venous injuries, and 31.6% of combin ed arterial and venous injuries, and was not related to venous repair or ligation. Seven delayed fasciotomies were performed either for vasc ular repair failure (5 patients) or compartment syndrome (2 patients). The highest incidence was for popliteal vessel injury (arterial 57%, combined 61%). Of the 33 lower-extremity fasciotomies, 58% were for po pliteal vessel injury. In 51 combined injuries of the lower extremity, only 7 (19%) of 38 patients with injury above the knee required fasci otomy, as compared with 8 (62%) of 13 with injury to the popliteal ves sels (P<.001), with or without venous repair. There were 3 amputations , all resulting from vascular repair failure. Conclusions: The presenc e of a combined vascular injury or the need for venous ligation does n ot necessitate routine fasciotomy. The need for fasciotomy may be maxi mal for injuries to popliteal vessels.