title: Delayed Primary Closure of Fasciotomy Incisions in the Lower Leg: Do We Need to Change Our Strategy?
abstract: OBJECTIVE
  The primary purpose of this study is to determine whether a strategy of bringing patients back to the operating room for successive debridements allows for the eventual delayed primary closure (DPC) of fasciotomy wounds.
  
  
  METHODS
  Retrospective cohort study. Data were collected from medical records and radiographs.
  
  
  METHODS
  Two urban level 1 trauma centers.
  
  
  METHODS
  One hundred four adult patients with acute compartment syndrome in the setting of a tibia fracture (open or closed).
  
  
  METHODS
  All patients underwent decompressive fasciotomies with closure by either DPC or split-thickness skin grafting (STSG) during a subsequent surgical procedure.
  
  
  METHODS
  Number of fasciotomy wounds closed by DPC after the initial fasciotomy procedure.
  
  
  RESULTS
  Of the 104 patients brought to the operating room for their first debridement after their fasciotomies, 19 patients (18%) were treated with DPC, whereas 42 patients (40%) were closed with STSG because they were believed to be too swollen to allow for primary closure by the treating surgeon. Three of the remaining 43 patients were treated with DPC during their second debridement. No patients who underwent more than 2 washouts could be treated with DPC. No patients who sustained open fractures were able to be closed by DPC (P = 0.02). Patients who underwent STSG on their first postfasciotomy procedure had a significantly shorter hospital stay than patients who underwent additional procedures before closure (12.2 vs. 17.4 days; P = 0.005).
  
  
  CONCLUSIONS
  Fasciotomy wounds that are not able to be primarily closed during their first postfasciotomy surgical procedure are rarely closed through DPC techniques. Early skin grafting of these wounds should be considered, especially in the clinical setting of an open injury, because it significantly decreases the length of hospital stay. Other techniques that avoid repeated debridements and attempted closures might also help reduce hospital stay.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; and †Carilion Clinic Orthopaedics, Virginia Tech Carilion School of Medicine, Roanoke, VA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weaver
authors.forename: Trevor M
authors.initials: TM
authors.lastname: Owen
authors.forename: Jordan H
authors.initials: JH
authors.lastname: Morgan
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003161:Compartment Syndromes / Q000150:complications / Q000601:surgery; D003646:Debridement / Q000379:methods*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery*; D055815:Young Adult