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Yoğun Y, Bezirgan U, Ertan MB, Savran MD, Kindan P, Kalem M, Armangil M. Comparison of Negative-Pressure Wound Therapy and Gradual Wound Approximation Treatments for Infected Fasciotomy Wounds. INT J LOW EXTR WOUND 2024:15347346241266652. [PMID: 39033381 DOI: 10.1177/15347346241266652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Negative-pressure wound therapy (NPWT) and gradual wound approximation (GWA) are effective and reliable methods of treating fasciotomy wounds. However, the effectiveness of these 2 methods in treating infected wounds remains unclear. The aim of our study was to compare these 2 delayed primary closure methods of treating infected fasciotomy wounds on the limbs. Patients who underwent fasciotomy surgery on the extremities after sustaining crushing injuries in the 2023 Kahramanmaraş-centered earthquakes and who were referred owing to infected open wounds during follow-up were included in the study. Patients who completed the wound closure process at our clinic were divided into 2 groups: the NPWT and GWA groups. Using retrospectively collected data, the groups were compared in terms of demographic characteristics, time until wound closure, number of surgeries, skin graft requirements, and complications. Laboratory parameters were also examined. Thirteen patients, (with 21 wounds) who underwent NPWT and 14 (with 22 wounds) who underwent GWA, were examined. The average age of the NPWT group was 32.85 ± 18.37 years, whereas that of the GWA group was 25.21 ± 16.31 years. The number of surgeries in the NPWT and GWA groups were 5.38 ± 2.11 and 4.23 ± 1.27, respectively, and the difference was statistically significant (P = .040). The average wound closure times of the NPWT and GWA groups (P = .0210) (11.00 ± 4.86 days and 8.27 ± 2.41 days, respectively) also differed significantly. Skin grafting was performed in 5 patients in the NPWT group and 2 in the GWA group. There were no significant differences between the 2 groups in terms of skin graft requirements or complication rates. NPWT and GWA are effective and reliable methods of closing infected fasciotomy wounds. Closure of these wounds can be achieved in a shorter time and with fewer surgeries using GWA than using NPWT.
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Affiliation(s)
- Yener Yoğun
- Hand Surgery Unit, Van Training and Research Hospital, Van, Turkey
| | - Uğur Bezirgan
- Orthopedics and Traumatology Department, Hand Surgery Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Batu Ertan
- Orthopedics and Traumatology Department, Medicana International Ankara Hospital, Ankara, Turkey
| | - Merve Dursun Savran
- Orthopedics and Traumatology Department, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Peri Kindan
- Orthopedics and Traumatology Department, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mahmut Kalem
- Orthopedics and Traumatology Department, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Armangil
- Orthopedics and Traumatology Department, Hand Surgery Unit, Ankara University Faculty of Medicine, Ankara, Turkey
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Arumugam PK, Muthukumar V, Bamal R. Utility of Shoelace Technique in Closure of Fasciotomy Wounds in Electric Burns. J Burn Care Res 2021; 42:538-544. [PMID: 33161435 DOI: 10.1093/jbcr/iraa200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST-7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST-7 days (range 6-10) as compared to Group C-20 days (range 12-48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.
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Affiliation(s)
- Praveen Kumar Arumugam
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Rahul Bamal
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India.,School of Medicine, Griffith University, Gold Coast, Australia
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Lamplot JD, Wang D, Weiss LJ, Baum M, Zeidler K, Mack C, Barnes RP, Warren RF, Taylor SA, Rodeo SA. Lower Extremity Compartment Syndrome in National Football League Athletes. Sports Health 2021; 13:198-202. [PMID: 33428552 DOI: 10.1177/1941738120973674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence of lower extremity compartment syndrome in National Football League (NFL) athletes and report the mechanisms of injury, methods of treatment, and subsequent days missed. We review the existing literature on lower extremity compartment syndrome in athletic populations. HYPOTHESIS Lower extremity compartment syndrome occurs with a low incidence in NFL athletes, and there is a high return-to-play rate after surgical management of acute compartment syndrome. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS A retrospective review of recorded cases of lower extremity compartment syndrome from 2000 to 2017 was performed using the NFL Injury Surveillance System and electronic medical record system. Epidemiological data, injury mechanism, rates of surgery, and days missed due to injury were recorded. RESULTS During the study period, 22 cases of leg compartment syndrome in 21 athletes were recorded. Of these injuries, 50% occurred in games and 73% were the result of a direct impact to the leg. Concomitant tibial fracture was noted in only 2 cases (9.1%) and there was only 1 reported case of chronic exertional compartment syndrome. Surgery was documented in 15 of 22 cases (68.2%). For acute nonfracture cases, the average time missed due to injury was 24.2 days (range, 5-54 days), and all were able to return to full participation within the same season. CONCLUSION NFL athletes with acute leg compartment syndrome treated with surgery exhibited a high rate of return to play within the same season. CLINICAL RELEVANCE Although compartment syndrome is a relatively rare diagnosis among NFL players, team physicians and athletic trainers must maintain a high index of suspicion to expediently diagnose and treat this potentially limb-threatening condition.
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Affiliation(s)
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California
| | - Leigh J Weiss
- New York Giants Football Club, East Rutherford, New Jersey
| | - Michael Baum
- New York Giants Football Club, East Rutherford, New Jersey
| | | | | | | | - Russell F Warren
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
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Abstract
Compartment syndrome is an acute limb-threatening condition typically treated with emergency fasciotomy. Although limbs often are saved, ischemia can cause irreversible neurologic damage to the extremity. Patients with upper extremity compartment syndrome may lose fine motor function, which can result in long-term impairment of perceived quality of life. This article reviews the anatomy, physiology, presentation, diagnosis, and treatment of upper extremity compartment syndrome, including rehabilitation, which can reduce complications that occur even in patients who were promptly and properly treated.
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Aedo-Martín D, Navarro-Suay R, García-Cañas R, Fernández-Gayol M, Vethencourt-Koifmann R, Areta-Jiménez FJ. Use of Oxygen Tissue Monitoring in Patients With Compartment Syndrome: Two Clinical Cases and Literature Review. Mil Med 2020; 184:e475-e479. [PMID: 30371908 DOI: 10.1093/milmed/usy270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Compartment syndrome is defined as the pathology caused by the increase of pressure within a muscular compartment to the point where the vascular perfusion necessary for the viability of the tissues included therein is reduced. The diagnosis is established by clinical exam and pressure measurement. Measurement of intracompartmental pressure is an invasive method with no option of easy continuous monitoring. Continuous tissue oximetry, using near-infrared light spectroscopy, can estimate soft-tissue oxygenation several centimeters below the sensor placement. This method of monitoring has been used successfully in the diagnosis of compartment syndrome, presenting itself as a non-invasive method of continuous measurement that can be a very useful alternative in complex situations or doubtful cases. We present two clinical cases of patients with acute compartment syndrome, in which the use of near-infrared light spectroscopy was determinant, both for the diagnosis and to verify the surgical treatment performed.
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Affiliation(s)
- Daniel Aedo-Martín
- Central Hospital of Defense "Gómez Ulla", Trauma and Orthopedic Surgery Department, Glorieta del Ejército s/n, Madrid, Spain
| | - Ricardo Navarro-Suay
- Central Hospital of Defense "Gómez Ulla", Anesthesia and Critical Care Department, Glorieta del Ejército s/n, Madrid, Spain
| | - Rafael García-Cañas
- Central Hospital of Defense "Gómez Ulla", Trauma and Orthopedic Surgery Department, Glorieta del Ejército s/n, Madrid, Spain
| | - Marcos Fernández-Gayol
- Central Hospital of Defense "Gómez Ulla", Trauma and Orthopedic Surgery Department, Glorieta del Ejército s/n, Madrid, Spain
| | - Ricardo Vethencourt-Koifmann
- Central Hospital of Defense "Gómez Ulla", Trauma and Orthopedic Surgery Department, Glorieta del Ejército s/n, Madrid, Spain
| | - Francisco Javier Areta-Jiménez
- Central Hospital of Defense "Gómez Ulla", Trauma and Orthopedic Surgery Department, Glorieta del Ejército s/n, Madrid, Spain
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Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:479-485. [PMID: 30145669 DOI: 10.1007/s00590-018-2299-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chronic exertional compartment syndrome (CECS) is an overuse disorder typically affecting an athletic population. CECS is a diagnosis based on history and intracompartmental pressure (ICP) testing. CECS patients can be treated surgically by fasciotomy; however, research on the relationship between ICP and patient symptoms and also between ICP and patient-reported outcome post-fasciotomy is limited. This study aims to (1) assess functional outcome and patient satisfaction post-fasciotomy and (2) identify any potential correlation between ICP and reported levels of pain. METHODS 138 CECS patients who had ICP measurements and subsequently underwent fasciotomy were identified from our regional service for exercise-induced lower limb extremity pain between January 2000 and March 2017. Clinical outcomes were recorded at the time of ICP testing and in the post-operative follow-up clinic. Pain was reported using a verbal rating scale (VRS) ('low', 'moderate' or 'high') or as a visual analogue score (VAS) 0-10 (0 = least painful, 10 = most painful). Spearman's ranked correlation test was used to calculate correlation between ICP and reported pain. RESULTS A total of 138 patients were eligible for inclusion in this study (mean age 29.7 ± 9.7 years, 110 M, 28 F) of which 109 patients (VRS n = 61, VAS n = 48) reported pain level at pre- and post-operative stages. Mean pre-operative VAS score was 8.52 ± 0.71, and decreased to 0.77 ± 0.69 post-operatively. An insignificant positive correlation (r = 0.046, two-tailed p = 0.76) was found between VAS pain and ICP. A significant moderate positive correlation (r = 0.497, two-tailed p = 0.01) was found between VRS pain and ICP. CONCLUSION Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.
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Brinley A, Chakravarthy B, Kiester D, Hoonpongsimanont W, McCoy CE, Lotfipour S. Compartment Syndrome with Rhabdomyolysis in a Marathon Runner. Clin Pract Cases Emerg Med 2018; 2:197-199. [PMID: 30083631 PMCID: PMC6075483 DOI: 10.5811/cpcem.2018.4.37957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/19/2018] [Indexed: 11/11/2022] Open
Abstract
A 38-year-old female seasoned marathon runner presented to the emergency department (ED) with increasing right lower extremity pain after running two mid-distance races in one weekend. The patient had previously run many two-day races and longer distances, but recently had gained weight and had not been training. This case report details her presenting symptoms, evaluation, review of the literature, and treatment with attention to the factors that led to the development of her pathologies.
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Affiliation(s)
- Alaina Brinley
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Douglas Kiester
- University of California, Irvine, Department of Orthopedics, Orange, California
| | | | - C Eric McCoy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Shahram Lotfipour
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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Skeletal Muscle Lymphoma Presenting with Chronic Compartment Syndrome of Leg after Trauma. Case Rep Oncol Med 2018; 2018:4078672. [PMID: 29808140 PMCID: PMC5902122 DOI: 10.1155/2018/4078672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/18/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022] Open
Abstract
Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.
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Anders M, Mutty C, Cornwall A. Geographic variation in fasciotomy during operative management of tibia fractures. J Orthop 2015; 13:225-9. [PMID: 27408482 DOI: 10.1016/j.jor.2015.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of acute or impending compartment syndrome (ACS) remains a clinical challenge. ACS is a clinical diagnosis, and may be associated with variation in its definition, as well as individual threshold for fasciotomy. We examined regional and state variation in rates of lower extremity fasciotomy associated with operatively managed tibia fractures. METHODS A total of 313,344 surgically treated tibia fractures were identified via Current Procedural Terminology (CPT) codes using PearlDiver, a private-payer medical record database. Data from the PearlDiver database was compared to the National Trauma Data Bank trauma registry data to corroborate calculated fasciotomy rates. RESULTS The aggregate United States fasciotomy rate derived from PearlDiver was 2.57%. State fasciotomy rates were wide-ranging (0.03%-11.86%) with an average state rate of 2.22% (n = 47, SD = 2.27). CONCLUSIONS There was significant state-to-state variation in the use of fasciotomy during operative management of tibial fractures. Various factors may have contributed to the observed difference of state fasciotomy rates. LEVEL OF EVIDENCE This is a Level III epidemiological study retrospectively comparing geographic rates of fasciotomy during operative management of tibia fractures.
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Affiliation(s)
- Mark Anders
- State University of New York at Buffalo, Dept. of Orthopaedics, Erie County Medical Center, Buffalo, NY 14215, United States
| | - Christopher Mutty
- State University of New York at Buffalo, Dept. of Orthopaedics, Erie County Medical Center, Buffalo, NY 14215, United States
| | - Allison Cornwall
- State University of New York at Buffalo, Dept. of Orthopaedics, Erie County Medical Center, Buffalo, NY 14215, United States
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