RT Journal
A1 Abouezzi Z, Nassoura Z, Ivatury RR, Porter JM, Stahl WM
T1 A critical reappraisal of indications for fasciotomy after extremity vascular trauma
JF Archives of Surgery
JO Archives of Surgery
YR 1998
FD May 1
VO 133
IS 5
SP 547
OP 551
DO 10.1001/archsurg.133.5.547
UL http://dx.doi.org/10.1001/archsurg.133.5.547
AB Objective 
    To critically reevaluate the indications for fasciotomy in vascular trauma of the extremities.Design 
    Case-control study.Setting 
    Level I trauma center.Materials and Methods 
    One hundred sixty-three vascular injuries to the extremeties were analyzed. Fasciotomy as an adjunct to vascular repair was performed in 45 limbs (28%), based either on the nature of injury or measured compartment pressure of greater than 35 mm Hg.Main Outcome Measures 
    Need for fasciotomy or limb amputation.Results 
    Fasciotomy was performed for 29.5% of isolated arterial injuries, 15.2% of isolated venous injuries, and 31.6% of combined arterial and venous injuries, and was not related to venous repair or ligation. Seven delayed fasciotomies were performed either for vascular 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 popliteal vessel injury. In 51 combined injuries of the lower extremity, only 7 (19%) of 38 patients with injury above the knee required fasciotomy, as compared with 8 (62%) of 13 with injury to the popliteal vessels (P<.001), with or without venous repair. There were 3 amputations, all resulting from vascular repair failure.Conclusions 
    The presence of a combined vascular injury or the need for venous ligation does not necessitate routine fasciotomy. The need for fasciotomy may be maximal for injuries to popliteal vessels.