Complications after fasciotomy revision and delayed compartment release in combat patients.

Amber E. Ritenour, Warren C. Dorlac, Raymond Fang, Timothy Woods, Donald H. Jenkins, Stephen F. Flaherty, Charles E. Wade, John B. Holcomb

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation. METHODS: A retrospective review was performed of combat casualties who underwent fasciotomies in Iraq, Afghanistan, or at Landstuhl Regional Medical Center between January 1, 2005 and August 31, 2006. Outcomes were rates of muscle excision, major amputation, and mortality. RESULTS: A total of 336 patients underwent 643 fasciotomies. Most were to the lower leg (49%) and forearm (23%). Patients who underwent a fasciotomy revision had higher rates of muscle excision (35% vs. 9%, p < 0.01) and mortality (20% vs. 6%, p < 0.01) than those who did not receive a revision. The anterior and deep compartments of the lower leg were the most commonly unopened. Patients who underwent fasciotomy after evacuation had higher rates of muscle excision (25% vs. 11%), amputation (31 vs. 15%), and mortality (19% vs. 5%) than patients who received their fasciotomies in the combat theater (p < 0.01). Patients who underwent revisions or delayed fasciotomies had higher Injury Severity Score and larger burns as well as lower systolic blood pressure, acidosis, and more pressor use during air evacuation. These patients also received more blood products at Landstuhl Regional Medical Center. CONCLUSION: Fasciotomy revision was associated with a fourfold increase in mortality. The most common revision procedures were extension of fascial incisions and opening new compartments. The most commonly unopened compartment was the anterior compartment of the lower leg. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality.

Original languageEnglish (US)
JournalThe Journal of trauma
Volume64
Issue number2 Suppl
StatePublished - Feb 1 2008
Externally publishedYes

Fingerprint

Amputation
Mortality
Muscles
Leg
Air
Fasciotomy
Blood Pressure
Afghanistan
Compartment Syndromes
Iraq
Injury Severity Score
Explosions
Acidosis
Burns
Forearm
Anatomy
Necrosis
Extremities
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Ritenour, A. E., Dorlac, W. C., Fang, R., Woods, T., Jenkins, D. H., Flaherty, S. F., ... Holcomb, J. B. (2008). Complications after fasciotomy revision and delayed compartment release in combat patients. The Journal of trauma, 64(2 Suppl).

Complications after fasciotomy revision and delayed compartment release in combat patients. / Ritenour, Amber E.; Dorlac, Warren C.; Fang, Raymond; Woods, Timothy; Jenkins, Donald H.; Flaherty, Stephen F.; Wade, Charles E.; Holcomb, John B.

In: The Journal of trauma, Vol. 64, No. 2 Suppl, 01.02.2008.

Research output: Contribution to journalArticle

Ritenour, AE, Dorlac, WC, Fang, R, Woods, T, Jenkins, DH, Flaherty, SF, Wade, CE & Holcomb, JB 2008, 'Complications after fasciotomy revision and delayed compartment release in combat patients.', The Journal of trauma, vol. 64, no. 2 Suppl.
Ritenour AE, Dorlac WC, Fang R, Woods T, Jenkins DH, Flaherty SF et al. Complications after fasciotomy revision and delayed compartment release in combat patients. The Journal of trauma. 2008 Feb 1;64(2 Suppl).
Ritenour, Amber E. ; Dorlac, Warren C. ; Fang, Raymond ; Woods, Timothy ; Jenkins, Donald H. ; Flaherty, Stephen F. ; Wade, Charles E. ; Holcomb, John B. / Complications after fasciotomy revision and delayed compartment release in combat patients. In: The Journal of trauma. 2008 ; Vol. 64, No. 2 Suppl.
@article{33cc0d5c5f6540958e3aa5318a795daf,
title = "Complications after fasciotomy revision and delayed compartment release in combat patients.",
abstract = "BACKGROUND: Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation. METHODS: A retrospective review was performed of combat casualties who underwent fasciotomies in Iraq, Afghanistan, or at Landstuhl Regional Medical Center between January 1, 2005 and August 31, 2006. Outcomes were rates of muscle excision, major amputation, and mortality. RESULTS: A total of 336 patients underwent 643 fasciotomies. Most were to the lower leg (49{\%}) and forearm (23{\%}). Patients who underwent a fasciotomy revision had higher rates of muscle excision (35{\%} vs. 9{\%}, p < 0.01) and mortality (20{\%} vs. 6{\%}, p < 0.01) than those who did not receive a revision. The anterior and deep compartments of the lower leg were the most commonly unopened. Patients who underwent fasciotomy after evacuation had higher rates of muscle excision (25{\%} vs. 11{\%}), amputation (31 vs. 15{\%}), and mortality (19{\%} vs. 5{\%}) than patients who received their fasciotomies in the combat theater (p < 0.01). Patients who underwent revisions or delayed fasciotomies had higher Injury Severity Score and larger burns as well as lower systolic blood pressure, acidosis, and more pressor use during air evacuation. These patients also received more blood products at Landstuhl Regional Medical Center. CONCLUSION: Fasciotomy revision was associated with a fourfold increase in mortality. The most common revision procedures were extension of fascial incisions and opening new compartments. The most commonly unopened compartment was the anterior compartment of the lower leg. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality.",
author = "Ritenour, {Amber E.} and Dorlac, {Warren C.} and Raymond Fang and Timothy Woods and Jenkins, {Donald H.} and Flaherty, {Stephen F.} and Wade, {Charles E.} and Holcomb, {John B.}",
year = "2008",
month = "2",
day = "1",
language = "English (US)",
volume = "64",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2 Suppl",

}

TY - JOUR

T1 - Complications after fasciotomy revision and delayed compartment release in combat patients.

AU - Ritenour, Amber E.

AU - Dorlac, Warren C.

AU - Fang, Raymond

AU - Woods, Timothy

AU - Jenkins, Donald H.

AU - Flaherty, Stephen F.

AU - Wade, Charles E.

AU - Holcomb, John B.

PY - 2008/2/1

Y1 - 2008/2/1

N2 - BACKGROUND: Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation. METHODS: A retrospective review was performed of combat casualties who underwent fasciotomies in Iraq, Afghanistan, or at Landstuhl Regional Medical Center between January 1, 2005 and August 31, 2006. Outcomes were rates of muscle excision, major amputation, and mortality. RESULTS: A total of 336 patients underwent 643 fasciotomies. Most were to the lower leg (49%) and forearm (23%). Patients who underwent a fasciotomy revision had higher rates of muscle excision (35% vs. 9%, p < 0.01) and mortality (20% vs. 6%, p < 0.01) than those who did not receive a revision. The anterior and deep compartments of the lower leg were the most commonly unopened. Patients who underwent fasciotomy after evacuation had higher rates of muscle excision (25% vs. 11%), amputation (31 vs. 15%), and mortality (19% vs. 5%) than patients who received their fasciotomies in the combat theater (p < 0.01). Patients who underwent revisions or delayed fasciotomies had higher Injury Severity Score and larger burns as well as lower systolic blood pressure, acidosis, and more pressor use during air evacuation. These patients also received more blood products at Landstuhl Regional Medical Center. CONCLUSION: Fasciotomy revision was associated with a fourfold increase in mortality. The most common revision procedures were extension of fascial incisions and opening new compartments. The most commonly unopened compartment was the anterior compartment of the lower leg. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality.

AB - BACKGROUND: Incomplete or delayed fasciotomies are associated with muscle necrosis and death in civilian trauma. Combat explosions severely damage tissue and distort normal anatomy making fasciotomies challenging. Rapid air evacuation may delay treatment of patients with evolving extremity compartment syndrome. We investigated the impact of fasciotomy revision and delayed compartment release on combat casualties after air evacuation. METHODS: A retrospective review was performed of combat casualties who underwent fasciotomies in Iraq, Afghanistan, or at Landstuhl Regional Medical Center between January 1, 2005 and August 31, 2006. Outcomes were rates of muscle excision, major amputation, and mortality. RESULTS: A total of 336 patients underwent 643 fasciotomies. Most were to the lower leg (49%) and forearm (23%). Patients who underwent a fasciotomy revision had higher rates of muscle excision (35% vs. 9%, p < 0.01) and mortality (20% vs. 6%, p < 0.01) than those who did not receive a revision. The anterior and deep compartments of the lower leg were the most commonly unopened. Patients who underwent fasciotomy after evacuation had higher rates of muscle excision (25% vs. 11%), amputation (31 vs. 15%), and mortality (19% vs. 5%) than patients who received their fasciotomies in the combat theater (p < 0.01). Patients who underwent revisions or delayed fasciotomies had higher Injury Severity Score and larger burns as well as lower systolic blood pressure, acidosis, and more pressor use during air evacuation. These patients also received more blood products at Landstuhl Regional Medical Center. CONCLUSION: Fasciotomy revision was associated with a fourfold increase in mortality. The most common revision procedures were extension of fascial incisions and opening new compartments. The most commonly unopened compartment was the anterior compartment of the lower leg. Patients who underwent delayed fasciotomies had twice the rate of major amputation and a threefold higher mortality.

UR - http://www.scopus.com/inward/record.url?scp=43349102162&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43349102162&partnerID=8YFLogxK

M3 - Article

C2 - 18376159

AN - SCOPUS:43349102162

VL - 64

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2 Suppl

ER -