Rao Appajosula S, Scalea Thomas M, Feliciano David V, Harfouche Melike N
R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Am Surg. 2025 Jul;91(7):1108-1112. doi: 10.1177/00031348241244629. Epub 2024 Apr 8.
IntroductionFour-compartment calf fasciotomy (CF) can be limb-saving. Prophylactic fasciotomy (PP) is advised in high-risk situations to prevent limb loss. Calf fasciotomy can cause significant morbidity, particularly if performed unnecessarily. We hypothesized that selective use of fasciotomies (SF) after lower-extremity vascular injury would lead to a lower rate of overall fasciotomies without an increase in limb complications than prophylactic fasciotomies (PFs).MethodsTrauma patients who sustained lower-extremity vascular injury that required operative repair at a high-volume trauma center were retrospectively reviewed and grouped by SF or PF (2016-2022). SF were individuals who were observed and underwent CF only if signs of compartment syndrome developed, whereas PF were individuals who underwent CF without signs of compartment syndrome. The primary outcome was amputation rate. Secondary outcomes were fasciotomy rate, need for reoperative vascular surgery, and clinical characteristics predisposing use of PF.ResultsOf 101 overall patients, 30 patients (29.4%) had PF. Of the remaining 71 (SF group), 43.7% (n = 31) were spared CF. The median time from injury to vascular repair in both groups was the same (7 hours, = .15). There was no difference in rate of vascular reoperation per group (PF = 26.7% vs SF = 23.9%, = .77). The only clinical characteristic associated with PF was need for arterial shunt (OR 4.2, = .028).ConclusionsIn trauma patients with lower-extremity vascular injury undergoing vascular repair, selective use of fasciotomy can spare almost half of patients the need for fasciotomy without an increase in limb complications.
引言
四室小腿筋膜切开术（CF）可挽救肢体。在高危情况下建议进行预防性筋膜切开术（PP）以防止肢体丧失。小腿筋膜切开术可导致严重的并发症，尤其是在不必要进行手术时。我们假设，与预防性筋膜切开术（PF）相比，在下肢血管损伤后选择性使用筋膜切开术（SF）将导致总体筋膜切开术的发生率更低，且肢体并发症不会增加。
方法
回顾性分析在一家大型创伤中心接受需要手术修复的下肢血管损伤的创伤患者，并根据SF或PF进行分组（2016 - 2022年）。SF组是仅在出现骨筋膜室综合征体征时才接受观察并进行CF的患者，而PF组是在没有骨筋膜室综合征体征的情况下接受CF的患者。主要结局是截肢率。次要结局包括筋膜切开术发生率、再次进行血管手术的需求以及倾向于使用PF的临床特征。
结果
在总共101例患者中，30例患者（29.4%）接受了PF。在其余71例（SF组）中，43.7%（n = 并避免了CF。两组从受伤到血管修复的中位时间相同（7小时，P = 0.15）。每组的血管再次手术率没有差异（PF = 26.7% 对SF = 23.9%，P = 0.77）。与PF相关的唯一临床特征是需要进行动脉分流（OR 4.2，P = 0）。
结论
在接受血管修复的下肢血管损伤创伤患者中，选择性使用筋膜切开术可使近一半的患者无需进行筋膜切开术，且肢体并发症不会增加。 31）避免了CF。两组从受伤到血管修复的中位时间相同（7小时，P = 0.15）。每组的血管再次手术率没有差异（PF = 26.7% 对SF = 23.9%，P = 0.77）。与PF相关的唯一临床特征是需要进行动脉分流（OR 4.2，P = 0.028）。
结论
在接受血管修复的下肢血管损伤创伤患者中，选择性使用筋膜切开术可使近一半的患者无需进行筋膜切开术，且肢体并发症不会增加。
