The effect of early versus late fasciotomy in the management of extremity trauma.
BACKGROUND
Recent reports have demonstrated an increase in the number of complications associated with delayed timing of fasciotomy for trauma. This study examines the effectiveness of early (less than 12 hours) versus late (more than 12 hours) fasciotomy in the injured extremity.


METHODS
This is a retrospective review of 88 patients undergoing fasciotomy for extremity trauma admitted to the University of Cincinnati from January 1990 through December 1995. Records were reviewed for demographics, compartment pressures, time and type of fasciotomy, complications, limb salvage, and mortality. Statistical analysis was determined with chi-squared, multivariant regression analysis, and Student's t test with significance at p less than 0.05.


RESULTS
Sixty-one (69%) patients had fasciotomy performed before 12 hours and twenty-seven (31%) after 12 hours. Although the rates of infection differed significantly between the two groups (7.3% for early versus 28% for late), the rates of limb salvage and neurologic sequelae were similar. Age, mechanism, shock, associated injuries, and time to fasciotomy were not predictive of complications.


CONCLUSIONS
Fasciotomy for trauma is most efficacious when performed early. However, when performed late, it results in similar rates of limb salvage as compared with early fasciotomy but at the increased risk of infection. These results support aggressive use of fasciotomy in extremity trauma regardless of time of diagnosis.
Williams
A B
AB
Department of Surgery, University of Cincinnati College of Medicine, Ohio, USA.
Luchette
F A
FA
Papaconstantinou
H T
HT
Lim
E
E
Hurst
J M
JM
Johannigman
J A
JA
Davis
K
K
D000328:Adult; D000671:Amputation, Surgical; D001134:Arm Injuries / Q000401:mortality / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000401:mortality / Q000601:surgery*; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing