Abstract

GOMEZ-HOYOS, Juan Carlos  and  MORALES, Carlos Hernando. Prophylactic fasciotomy and compartment syndrome of the extremities: are there justifiable indications?. rev. colomb. cir. [online]. 2011, vol.26, n.2, pp.101-110. ISSN 2011-7582.

Background. Fasciotomy is the core intervention to treat established compartment syndrome, however the ideal intervention would be one able to prevent is occurrence. Fasciotomy can also be performed as a prophylactic procedure for compartment syndrome, considered by some to be the best option; but other authors consider it unjustifiable because it is not void of complications. We studied and analyzed the available evidence for the possible indications for prophylactic fasciotomy. Materials and Methods. We performed a literature search following the BestBET methodology, identifying studies that could determine the impact of prophylactic fasciotomy and risk factors for possible complications. The articles were reviewed according to the STROBE critical appraisal criteria. Results. Four retrospective observational studies were identified, three of them identified risk factors for prophylactic fasciotomy and its impact, while the other related to the identification of risk factors. The most common localization was the leg (68.4%), the clinical scenarios with the highest risk for compartment syndrome were combined arterial and venous vascular trauma (41.8%, OR 3.0, IC 1,4-6.1), vascular trauma (arterial 27.2% OR 10.4 IC 7.1-15.4, venous 23.4% OR 7.4 IC 4.5-12.4), Bone fracture with associated with vascular trauma (44% vs. 19%) and dislocation associated to vascular trauma (10.4% OR 3,5 IC 1.8-6.8). The risk increases significantly with popliteal vascular trauma, open fractures, proximal tibial fractures, and if knee dislocation occurs. There is no solid evidence to determine that ischemia time, hemorrrhage or the need for blood transfusion act as predictors for the need of fasciotomies. Conclusion. The decision to perform prophylactic fasciotomy is difficult, but in some cases of trauma with high risk of a compartment syndrome as: combined or simple vascular injury (mainly popliteal vessels), with or without fracture (mainly proximal tibia) or dislocation (especially knee dislocation), prophylactic fasciotomies may be recommendable. The consequences of a compartment syndrome are more significant than the possible complications of an unnecessary prophylactic fasciotomy.

Keywords : compartment syndromes; fascia; prophylaxis; wounds and injuries; extremity.

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