Limited evidence supports use of negative pressure wound therapy for management of fasciotomy wounds with regard to reducing time to wound closure and reducing need for skin grafting.

Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense.
Limited Evidence LIMITED EVIDENCE
Rationale
There was one moderate strength (Li, 2015) and three low strength (Zannis, 2009; Mittal, 2017; Krticka, 2016) studies evaluating wound management after fasciotomy. Li et al. found that use of negative pressure wound therapy resulted in a decrease in days to wound closure/coverage (9 days versus 14 days). Zannis et al. found that negative pressure wound therapy resulted in decreased need for split thickness skin graft in both the lower limb (17% versus 44%, RR 0.39) and upper limb (43% versus 66%, RR 0.67).

Of the three studies that reported important but rare outcomes including infection and/or other complications, all were underpowered to adequately assess these rare outcomes (subject sizes: 52 patients in Li et al., 63 patients in Krticka et al. and 50 patients in Mittal et al.). Krticka 2016 compared vacuum-assisted closure with dermatotaxis technique versus dressing fabrics and reported that dressing fabrics resulted in a higher rate of infection that was not statistically significant (9.5% versus 14.3%). For context, based on this rate of infection a study would require 1,478 patients (739 per group) to be adequately powered to detect a statistically significant difference with 80% power, assuming an alpha of 5%.

Mittal et al. compared two specific dermatotaxis techniques to aid wound closure without use of negative pressure wound therapy and found that use of tensioned wires (as opposed to sutures) resulted in higher risk of infection (12% versus 4%, RR 3).
  1. Li, W., Ji, L., Tao, W. Effect of vacuum sealing drainage in osteofascial compartment syndrome. International Journal of Clinical and Experimental Medicine 2015; 9: 16112-16116
  2. Mittal, N., Bohat, R., Virk, J. S., Mittal, P. Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases. Strategies in Trauma and Limb Reconstruction 2017; 0: 1-7
  3. Zannis, J., Angobaldo, J., Marks, M., DeFranzo, A., David, L., Molnar, J., Argenta, L. Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device. Annals of Plastic Surgery 2009; 4: 407-9
  4. Krticka, M., Ira, D., Bilik, A., Rotschein, P., Svancara, J. Fasciotomy closure using negative pressure wound therapy in lower leg compartment syndrome. Bratislavske Lekarske Listy 2016; 12: 710-714