Management of Fasciotomy Incisions After Acute Compartment Syndrome: Is Delayed Primary Closure More Feasible in Children Compared With Adults?

• Published in: Journal of pediatric orthopaedics Vol. 40; no. 4; p. e300
• Main Authors: Rademacher, Emily, Miller, Patricia E, Jordan, Eric, May, Collin J, Glotzbecker, Michael P, Bae, Donald S, Hedequist, Daniel J, Shore, Benjamin J
• Format: Journal Article
• Language: English
• Published: United States 01.04.2020
• Subjects: Adolescent; Adult; Child; Compartment Syndromes - surgery; Debridement - adverse effects; Debridement - methods; Fasciotomy - adverse effects; Fasciotomy - methods; Female; Humans; Infant, Newborn; Length of Stay - statistics & numerical data; Male; Skin Transplantation - methods; Surgical Flaps; Treatment Outcome; Wound Closure Techniques
• ISSN: 1539-2570
• DOI: 10.1097/BPO.0000000000001492

Recent adult literature has demonstrated that in the setting of acute compartment syndrome (ACS), if fasciotomy wounds are not closed after the first debridement, they are unlikely to be closed via delayed primary closure (DPC). The purpose of this study was to report the success of DPC through serial debridement in children with fasciotomy wounds secondary to ACS and to determine whether length of hospital stay is negatively affected by adopting a DPC strategy. We identified all patients treated with fasciotomy for ACS (aged 0 to18 y). Patient, injury, and treatment characteristics were summarized by fasciotomy treatment type. Patients were grouped as: primary closure, DPC, and flap or skin graft (F/SG). For patients who required additional debridements after initial fasciotomy, treatment success was defined as closure by DPC (without requiring F/SG). Multivariable logistic regression was used to determine factors associated with additional surgeries, complications, and treatment success. A total of 82 children underwent fasciotomies for ACS. Fifteen (18%) patients were treated with primary closure at the time of their initial fasciotomy and were excluded from the remainder of the analysis, 48 (59%) patients underwent DPC, and 19 (23%) patients were treated with F/SG. The majority of delayed fasciotomy wounds were successfully closed by DPC (48/67, 72%) and the rate of successful closure remained consistent with each successive operative debridement. There were no differences across DPC and F/SG groups with respect to age, method of injury, or injury severity. Patients who underwent F/SG remained in the hospital for an average of 12 days compared with 8 days for those who underwent DPC (P<0.001). In the setting of ACS, pediatric fasciotomy wounds that are not closed after the first postfasciotomy debridement still have a high likelihood of being closed through DPC with serial surgical debridement. In children, persisting with DPC strategy for fasciotomy closure after ACS is more successful than it is in adults. Level III.