A comparison of fasciotomy wound closure methods following extremity compartment syndrome at a regional trauma centre

Background: Extremity fasciotomy wound closure following acute compartment syndrome is often prohibited by residual swelling, producing wounds that significantly contribute to patient morbidity. The aim of this study was to assess patient and fasciotomy wound outcomes associated with dynamic closure (DYN), delayed primary closure (DPS) and split skin grafting (SSG) techniques. Methods: A retrospective review of all trauma-related compartment syndrome patients managed between January 2000 and March 2010 was conducted, and a comprehensive patient and wound outcomes analysis was performed. Results: DYN was employed in 109 wounds, DPS in 66 wounds and SSG in 7 wounds. DPS wounds achieved closure in a significantly shorter timescale than other methods (p = <0.05). DYN and SSG group wound closure times were comparable; however, SSG techniques were employed later post-fasciotomy. SSG patients had longer hospital stays (p = <0.05) and the lowest wound complication rate (0 %). Wound complication rates were significantly higher in the DYN (55 %) and DPS groups (15 %) (p = <0.05), and these wounds required a higher number of further surgical procedures. The need for repeated wound debridements was higher in the DYN group than any other (p = <0.05). Conclusions: DPS provided the fastest method of fasciotomy wound closure and the shortest inpatient stay. DYN techniques were associated with higher wound complication rates and the need for further surgical procedures. SSG techniques were associated with low complication rates and fewer surgical procedures and, if applied earlier, could result in shorter inpatient stay. Level of evidence IV, therapeutic study. © 2015, Springer-Verlag Berlin Heidelberg.