Department of Clinical Sciences, Lund University, Malmö, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
Department of Health Sciences, Lund University, Lund, Sweden.
Ann Vasc Surg. 2023 Jan;88:154-163. doi: 10.1016/j.avsg.2022.07.018. Epub 2022 Sep 2.
Acute Compartment Syndrome (ACS) is a significant complication after revascularization 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.
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 Pearson's chi-squared-and log-rank test, respectively.
E-GFR improved over the in-hospital period with 8.2 ml/min/1.73 m (95% confidence interval [CI] 2.4-14.1, P = 0.007) in the PF group and 4.4 ml/min/1.73 m (95% CI 1.2-7.7, P = 0.010) in the TF group, with no significant difference between the 2 groups (0.3 ml/min/1.73 m, 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.
Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies 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.
急性间隔综合征（ACS）是下肢急性缺血（ALI）再灌注后发生的一种严重并发症。高危患者有时会进行预防性筋膜切开术（PF）以预防 ACS。发生 ACS 的患者会进行治疗性筋膜切开术（TF）。筋膜切开术的最佳时机一直存在争议。本研究的目的是描述并比较接受 PF 和 TF 的患者的肾脏和伤口结局。
这是一项回顾性队列研究，纳入了 2006 年至 2018 年间接受 ALI 再灌注治疗后行 PF（n=40）或 TF（n=36）的 76 名患者。采用估算肾小球滤过率（e-GFR）评估肾功能，并分别在组内（配对样本 t 检验）和组间（方差分析）进行比较。分别采用 Pearson χ²检验和对数秩检验比较组间的伤口并发症和愈合时间。
PF 组 e-GFR 在住院期间逐渐升高，增加 8.2ml/min/1.73m（95%置信区间 [CI] 2.4-14.1，P=0.007），TF 组增加 4.4ml/min/1.73m（95% CI 1.2-7.7，P=0.010），但两组间无显著差异（0.3ml/min/1.73m，95% CI -6.7 至 7.4，P=0.93）。TF 后的伤口感染率更高（PF=60.6%，TF=82.4%，P=0.048），而 PF 后的其他伤口并发症发生率更高（PF=61.3%，TF=35.3%，P=0.036）。
总体而言，伤口并发症发生率较高，而住院期间肾功能逐渐改善。如果 ACS 需要筋膜切开术，更保守的筋膜切开术方法可以避免不必要的筋膜切开术，并减少伤口并发症，同时有潜力充分保留肾功能。如果能够早期诊断和治疗 ACS，这将是可行和安全的。
