Medline ® Abstracts for References 91,92

Sixty-six cases of acute compartment syndrome were treated by fasciotomy in forty-six extremities of forty-four patients. Fasciotomy performed early, that is, less than twelve hours after the onset of the compartment syndrome, resulted in normal function in 68 per cent of the extremities. Only 8 per cent of those having late fasciotomy had normal function. The complication rates for the early and late fasciotomized extremities were 4.5 per cent and 54 per cent, respectively. No significant differences in residual function or complication rate were noted with "open" or "closed" fasciotomy.

OBJECTIVE: To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome.

DESIGN: A retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should ideally have been performed earlier.

MATERIALS AND METHODS: Nine fasciotomies in five patients were identified where there was a delay of more than 35 hours after the injury. The average ischemic time was 56 hours (range 35-96 hours).

RESULTS: One patient died of multiorgan failure and septicemia. The remaining four patients required lower limb amputation, because of local infection and septicemia. The one late amputation was performed 6 months after the injury, because the patient was left with a functionless insensate foot. Where recognition of an established compartment syndrome is delayed for more than 8 to 10 hours, we propose that the traditional inevitable fasciotomy be reassessed.