Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb IschemiadRenal and Wound Outcomes

Background: Acute Compartment Syndrome (ACS) is a significant complication after revascu-larization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. Methods: A retrospective cohort study including 76 patients undergoing PF (n = 40) or TF (n = 36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pear-son's chi-squared-and log-rank test, respectively. Results: E-GFR improved over the in-hospital period with 8.2 ml/min/1.73 m2 (95% confidence interval [CI] 2.4e14.1, P = 0.007) in the PF group and 4.4 ml/min/1.73 m2 (95% CI 1.2e7.7, P = 0.010) in the TF group, with no significant difference between the 2 groups (0.3 ml/min/ 1.73 m2, 95% CI -6.7 to 7.4, P = 0.93). The wound infection rate was higher after TF (PF = 60.6 % and TF = 82.4 %, P = 0.048), whereas rate of other wound complications (PF = 61.3 % and TF = 35.3%, P = 0.036) was higher after PF. Conclusions: Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciot-omies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.

Automated summary

This study compared the effects of prophylactic fasciotomy (PF) and therapeutic fasciotomy (TF) on renal function and wound outcomes in patients. The study found that both groups had similar improvements in renal function, but the TF group had a higher wound infection rate, while the PF group had a higher rate of other wound complications. Therefore, a more conservative approach to fasciotomy may be possible and safe if early diagnosis and treatment of ACS can be ensured, avoiding unnecessary fasciotomies and reducing wound complications while preserving renal function.