Fasciotomy Methods
In the absence of reliable evidence, it is the opinion of the work group that fasciotomy technique (e.g. one vs two incision, placement of incisions) is less important than achieving complete decompression of the compartments of the affected extremity.
Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS, AOFAS, and SOMOS

Rationale

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.

FUTURE RESEARCH

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.


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