J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 9;9(12). doi: 10.5435/JAAOSGlobal-D-25-00096. eCollection 2025 Dec 1.
ABSTRACT
INTRODUCTION: This retrospective and systematic review examines wound closure rates across the fasciotomy approach and wound management technique for lower leg compartment syndrome.
METHODS: A retrospective review was done for adult patients treated with lower leg fasciotomy at one level 1 center from 2012 to 2022 by the CPT code. Patient data were collected, including time to fasciotomy closure and techniques used. P < 0.05 was considered significant. A systematic review was done for studies reporting time to wound closure or rates of skin grafting in the setting of fasciotomy by the surgical approach for lower leg acute compartment syndrome in accordance with the PRISMA guidelines.
RESULTS: Of 101 patients, mean time to closure was 9.83 ± 10.16 days. Time to closure was shorter for single-incision (7.00 ± 6.45 days) versus dual-incision fasciotomy (10.31 ± 10.60 days), although insignificantly. Wound management at the time of fasciotomy included VAC (n = 34, time to closure 9.29 ± 10.34 days), shoelace technique (n = 12, 7.36 ± 3.75 days), and packing (n = 37, 10.94 ± 10.56 days). 38.2% treated with VAC, 16.7% shoelace technique, and 67.6% packing required skin grafting (P = 0.043). No specific patient factors were associated with time to closure, or with early versus late closure, defined by median time to closure (6 days). Median was reported here, given the skew of our data, and is therefore more reflective of the central trend of our data. Skin grafting (30.2% versus 69.8%, P = 0.026), increasing LOS (9.25 ± 4.66 days versus 13.64 ± 8.68 days, P = 0.003), and ISS (7.20 ± 4.84 versus 10.79 ± 9.76, P = 0.028) were associated with delayed closure. ISS was the only factor significantly associated with delayed closure on multivariate analysis (P = 0.05). Table 5 outlines the 25 articles included for the systematic review.
CONCLUSION: Our analysis revealed trends toward increasing time to closure in dual-incision versus single-incision fasciotomy for lower leg compartment syndrome. Wound management markedly favored the wound vac or shoelace technique, corroborated by the results of our systematic review.
PMID:41364383 | DOI:10.5435/JAAOSGlobal-D-25-00096