Four low quality studies (Bible, 2013; Jang, 2017; Kanj, 2013; Heemskerk, 2003) examined various fasciotomy techniques displaying varying results and inconsistent outcomes, which led to the lack of an evidence-based recommendation for this topic.
Clinicians should consider the soft tissue envelope when determining incision placement as the literature does not clearly suggest an advantage or disadvantage for choosing different techniques. Surgeons should choose the fasciotomy technique deemed best to allow for full decompression of the involved compartments and may be tailored to other considerations such as plans for staged fixation. For the inexperienced clinician, it is recommended that the 2-incision method be used.
POSSIBLE HARMS OF IMPLEMENTATION
Incomplete fasciotomy can have severe consequences. In the war wounded, the need for fasciotomy revision is associated with a 4-fold increase in mortality.
While fasciotomy is not technically challenging, research into the most effective educational tools to improve fasciotomy techniques may be of benefit. A fasciotomy education program, as conducted in the U.S. military, improved survival rates however, the rates of delayed fasciotomy did not change.
- Bible, J. E., McClure, D. J., Mir, H. R. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. Journal of Orthopaedic Trauma 2013; 11: 607-11
- Jang, Y. S., Lee, B. H., Park, H. S. Lower amputation rate after fasciotomy by straight midline incision technique for a 22,900-V electrical injury to the upper extremities. Injury 2017; 11: 2590-2596
- Kanj, W. W., Gunderson, M. A., Carrigan, R. B., Sankar, W. N. Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes. Journal of Childrens Orthopaedics 2013; 3: 225-33
- Heemskerk, J., Kitslaar, P. Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies. World Journal of Surgery 2003; 6: 744-7