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Am Surg. 2008 Mar;74(3):217-20.

Dynamic wound closure for decompressive leg fasciotomy wounds.
Singh N, Bluman E, Starnes B, Andersen C.
Source
Vascular Surgery Service, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
Nhsingh@aol.com
Abstract
Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential
technique in trauma. The wounds that result from the standard two incision four-compartment leg
fasciotomy are often accompanied by a wide soft tissue opening that in the face of true
compartment syndrome are often impossible to close in a delayed primary fashion. We describe a
technique using a device that allows for dissipation of the workload across the wound margin
allowing for successful delayed primary closure. Consecutive patients who presented to the 28th
Combat Support Hospital in Baghdad, Iraq with a diagnosis of compartment syndrome of the leg,
impending compartment syndrome of the leg, or compartment syndrome of the leg recently
treated with fasciotomies were followed. All patients underwent placement of the Canica dynamic
wound closure device (Canica, Almonte, ON, Canada). Eleven consecutive patients treated at a
combat support hospital in support of Operation Iraqi Freedom underwent four-compartment
fasciotomies for penetrating injuries. There were five patients that underwent a vascular repair
[three superficial femoral artery (SFA) injuries and two below knee popliteal artery injuries] and six
patients that had orthopedic injuries (three comminuted tibial fractures, two fibula fractures, and
one closed pilon fracture). Patients returned to the operating room within 24 hours for washout
and wound inspection. Mean initial wound size was 8.1 cm; mean postplacement size was 2.7 cm;
average time to closure was 2.6 days. All patients were able to undergo primary wound closure of
the medial incision and placement of the Canica device over the lateral incision. Ten of the 11
patients (91%) could be closed in delayed primary fashion after application of the device. In our
series of patients with penetrating wartime injuries and compartment syndrome of the leg we have
found the use of this dynamic wound closure device to be extremely successful and expedient.

Publication Date: 5/16/2012 JBJS

Acute compartment syndrome of the forearm.

Andrew D Duckworth; Sarah E Mitchell; Samuel G Molyneux; Timothy O White; Charles M CourtBrown; Margaret M McQueen
BACKGROUND: The aims of this study were to document our experience with acute forearm
compartment syndrome and to determine the risk factors for the need for split-thickness skingrafting and the development of complications after fasciotomy.
METHODS: We identified from our trauma database all patients who underwent fasciotomy for an
acute forearm compartment syndrome over a twenty-two-year period. Diagnosis was made with
use of clinical signs in all patients, with compartment pressure monitoring used as a diagnostic
adjunct in some patients. Outcome measures were the use of split-thickness skin grafts and the
identification of complications following forearm fasciotomy.
RESULTS: There were ninety patients in the study cohort, with a mean age of thirty-three years
(range, thirteen to eighty-one years) and a significant male predominance (eighty-two patients; p <
0.001). A fracture of the radius or ulna, or both, was seen in sixty-two patients (69%), with softtissue injuries as the causative factor in twenty-eight (31%). The median time to fasciotomy was
twelve hours (range, two to seventy-two hours). Risk factors for requiring split-thickness skingrafting were younger age and a crush injury (p < 0.05 for both). Risk factors for the development of
complications were a delay in fasciotomy of more than six hours (p = 0.018) and preoperative
motor symptoms, which approached significance (p = 0.068).
CONCLUSIONS: Forearm compartment syndrome requiring fasciotomy predominantly affects males
and can occur following either a fracture or soft-tissue injury. Age is an important predictor of
undergoing split-thickness skin-grafting for wound closure. Complications occur in a third of
patients and are associated with an increasing time from injury to fasciotomy.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of
levels of evidence.

ABSTRACT
Background: Currently, the most common clinical scenario for compartment syndrome in children
is acute traumatic compartment syndrome of the leg. We studied the cause, diagnosis, treatment,
and outcome of acute traumatic compartment syndrome of the leg in children.

Methods: Forty-three cases of acute traumatic compartment syndrome of the leg in forty-two
skeletally immature patients were collected from two large pediatric trauma centers over a
seventeen-year period. All children with acute traumatic compartment syndrome underwent
fasciotomy. The mechanism of injury, date and time of injury, time to diagnosis, compartment
pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded.

Results: Thirty-five (83%) of the forty-two patients were injured in a motor-vehicle accident and
sustained tibial and fibular fractures. The average time from injury to fasciotomy was 20.5 hours
(range, 3.9 to 118 hours). In general, the functional outcome was excellent at the time of the latest
follow-up. No cases of infection were noted when fasciotomy was performed long after the injury.
At the time of the latest follow-up, forty-one (95%) of forty-three cases were associated with no
sequelae (such as pain, loss of function, or decreased sensation). The two patients who lost
function had fasciotomy 82.5 and eighty-six hours after the injury.

Conclusions: Despite a long period from injury to fasciotomy, most children who are managed for
acute traumatic compartment syndrome of the leg have an excellent outcome. This delay may
occur because acute traumatic compartment syndrome manifests itself more slowly in children or
because the diagnosis is harder to establish in this age group. The results of the present study
should raise awareness of late presentation and the importance of vigilance for developing
compartment syndrome in the early days after injury. Fasciotomy during the acute swelling phase,
even long after injury, produced excellent results with no cases of infection.
Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of
levels of evidence.