331 The Role of Prophylactic and Therapeutic Fasciotomy in Acute Limb Presentations. (4th May 2021)

• Record Type: Journal Article
• Authors: Ding, A; Machin, M; Onida, S; Davies, A
• Is Part Of: British journal of surgery. Volume 108(2021)Supplement 2
• Publication Date: 2021-05-04
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab134.547
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Acute compartment syndrome is a surgical emergency that can be of traumatic or non-traumatic nature. Missed or delayed diagnosis can cause significant morbidity. The aim of this systematic review was to assess outcomes following prophylactic and therapeutic fasciotomies performed for acute limb presentations. Method: This systematic review was undertaken following a predefined protocol registered with PROSPERO, in accordance with PRISMA guidelines. Searches of MEDLINE and Embase databases retrieved 623 articles; 19 articles were included in the study. A qualitative synthesis was performed due to heterogeneity between the studies. Results: Overall mortality rates of 0–19 % were reported for traumatic causes and 24.5–27% for non-traumatic causes. In general, comparative studies reported lower amputation rates (0–21.7% vs 6.6–50%) and neurological deficit rates in the prophylactic versus therapeutic fasciotomy arms (8.8–18% vs 12.5–42%). Complication rates of up to 42% and 35% were reported in traumatic and non-traumatic cases respectively, which included wound infection, nerve injury and ischaemic contractures. Conclusions: Prophylactic fasciotomies appear to have superior outcomes than therapeutic ones. There is insufficient evidence for a specific time cut-off for the performance of therapeutic fasciotomies; retrospective analysis of outcomes via a fasciotomy registry may help to guide future practice.