Two Urgency Categories, Same Outcome: No Difference After "Therapeutic" vs. "Prophylactic" Fasciotomy.

Autor:	Moran BJ; Department of General Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA., Quintana MT; George Washington University Hospital, Washington, DC, USA., Michael Scalea T; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA., DuBose J; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA., Feliciano DV; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Apr; Vol. 89 (4), pp. 614-620. Date of Electronic Publication: 2021 Jul 19.
DOI:	10.1177/00031348211031860
Abstrakt:	Objectives: Fasciotomy to treat or prevent compartment syndromes in patients with truncal or peripheral arterial injuries is a valuable adjunct. The objective of this study was to document the current incidence, indications, and outcomes of below knee fasciotomy in patients with femoropopliteal arterial injuries. Methods: The PROspective Observational Vascular Injury Treatment registry of the American Association for the Surgery of Trauma was utilized to identify patients undergoing two-incision four-compartment fasciotomy of the leg after repair of a femoropopliteal arterial injury. Outcomes after therapeutic versus prophylactic (surgeon label) fasciotomy were compared as was the technique of closure, that is, primary skin closure or application of a split-thickness skin graft (STSG). Results: From 2013 to 2018, fasciotomy was performed in 158 patients overall, including 95.6% (151/158) at the initial operation. In the group of 139 patients who survived to discharge, fasciotomies were labeled as therapeutic in 58.3% (81/139) and prophylactic in 41.7% (58/139). There were no significant differences between the therapeutic and prophylactic groups in amputation rates (14.8% vs. 8.6%, P = .919). Primary skin closure was achieved at a median of 5.0 days vs. 11.0 days for STSG ( P = .001). Conclusions: Over 55% of patients undergoing repair of an injury to a femoral or popliteal artery have a fasciotomy performed at the same operation. A "therapeutic" indication for fasciotomy continues to be more common than "prophylactic," while outcomes are identical in both groups.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu