Fasciotomy done for vascular trauma at a tertiary care centre in Sri Lanka

Abstract

Introduction Compartment syndrome is a major factor contributing to limb loss and poor outcome following lower limb vascular injuries. Method This is a retrospective study done on patients with vascular injuries and undergone fasciotomy at the accident service operation theatre (ASOT) at the national hospital of Sri Lanka (NHSL), during a period of one year. Cases with Incomplete documentation were excluded. Data on patient demographics, time of injury, and time of fasciotomy, associated fractures, muscle viability and outcome were collected. Results A total of 30 cases were included. 26 (86%) were males. Nine (30%) were upper limb and 21(70%) were lower limb fasciotomy. The cause for limb injuries were road traffic accidents (RTA) in 18 (58.1%), trap gun injury in five (16.1%). All the fasciotomy were done prior to revascularization. 19 (63.3%) had fractures (12 (63%) were open and seven (36%) closed). six (20%) fasciotomy were done for compartment syndrome, 24 (80%) were done prophylactically. Three patients with compartment syndrome had open fractures (50%) and three had closed fractures (50%). On fasciotomy, in four cases all four leg compartment muscles were non-viable, two had non-viable three compartments and one patient had non-viable two compartments. The mean delay in patients who had all compartments viable was 3.7 hours (2-6.5) and the mean delay in patients with three or four non-viable compartments was 12.2hours (7-24). This difference was statistically significant (p-0.0001). The fasciotomy delay was also significant (p-0.0001) between the patients who had an amputation and limb salvage. Overall amputation rate was 20% in this series. Mean time of delay from admission to NHSL to the time of fasciotomy was 1.8 hours (1-3.5). Mean time of injury to time of fasciotomy was 5.42 hours (2-24). Discussion Number of non-viable compartments is significantly associated with the duration between time of injury to time of fasciotomy(P-0.0001). Therefore we suggest early fasciotomy before transfer