Fasciotomy wounds associated with acute compartment syndrome: a systematic review of effective treatment

Abstract

Background Compartment syndrome of the limbs can occur in patients following limb trauma. The only definitive treatment is fasciotomy, i.e. a surgical procedure where the fascia is cut to relieve tension or pressure. The fasciotomy wounds created must be left open until the swelling has reduced enough to allow for closure of the wounds. The resulting wounds can be difficult to manage, and the wounds often cannot be closed without the use of split thickness skin grafts. Objectives To identify the best available evidence on the effectiveness of treatment options for managing fasciotomy wounds acquired due to treatment for acute compartment syndrome in the limbs. Inclusion criteria Types of participants Patients of either gender and any age who has acquired a fasciotomy wound as a result of treatment for acute compartment syndrome of the limb occurring as a result of injury (excluding compartment syndrome resulting from burns). Types of intervention(s) Studies that evaluate the effectiveness of different options for treating fasciotomy wounds. Types of studies Quantitative studies including randomized controlled trials, cohort studies and case series. Types of outcomes Outcomes considered were the duration for wound closure, rate of wound healing without the need for skin grafting, degree of scaring, length of stay, wound infection and dehiscence rates, neurological deficit rates and pain. Search strategy The search strategy aimed to find both published and unpublished studies using a comprehensive three-step search strategy. Studies published in English language, with human subjects, from January 1960 to June 2012 were considered for inclusion. Critical appraisal was conducted by two independent reviewers. Data collection Data were extracted from papers included in the review using the standardized data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Data analysis Quantitative data were pooled in statistical meta-analysis using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Effect sizes expressed as odds ratio (for categorical data) and their 95% confidence intervals were calculated for analysis. Heterogeneity was assessed statistically using the standard Chi-square. Where statistical pooling was not possible the findings were presented in narrative form including tables and figures. Results The systematic review found 32 studies that met the protocol criteria and passed critical appraisal (one randomized controlled trial, eight cohort studies and 23 case series). The 32 studies examined a wide variety of different wound treatment and closure techniques and greatly varied in the number and method of outcomes measured. As a result only the randomized controlled trial results and only four of the cohort studies could be meta-analyzed. Conclusions The systematic review found limited evidence on which to base practice decisions. The single randomized controlled trial should be replicated to confirm findings before practice change can be confidently recommended. The limited available evidence suggested that the vessel loop shoelace technique achieved wound closure quicker and with less need for split thickness skin graft than a negative pressure wound treatment system such as Vacuum Assisted Closure®. A negative pressure wound treatment system, such as Vacuum Assisted Closure®, appeared to achieve wound closure quicker than using the traditional saline soaked gauze with less need for split thickness skin grafts to achieve closure.