1: Surgery  1997 Oct;122(4):861-6 

The effect of early versus late fasciotomy in the management of extremity
trauma.

Williams AB, Luchette FA, Papaconstantinou HT, Lim E, Hurst JM, Johannigman JA,
Davis K Jr.

Department of Surgery, University of Cincinnati College of Medicine, Ohio, USA.

BACKGROUND: Recent reports have demonstrated an increase in the number of
complications associated with delayed timing of fasciotomy for trauma. This
study examines the effectiveness of early (less than 12 hours) versus late (more
than 12 hours) fasciotomy in the injured extremity. METHODS: This is a
retrospective review of 88 patients undergoing fasciotomy for extremity trauma
admitted to the University of Cincinnati from January 1990 through December
1995. Records were reviewed for demographics, compartment pressures, time and
type of fasciotomy, complications, limb salvage, and mortality. Statistical
analysis was determined with chi-squared, multivariant regression analysis, and
Student's t test with significance at p less than 0.05. RESULTS: Sixty-one (69%)
patients had fasciotomy performed before 12 hours and twenty-seven (31%) after
12 hours. Although the rates of infection differed significantly between the two
groups (7.3% for early versus 28% for late), the rates of limb salvage and
neurologic sequelae were similar. Age, mechanism, shock, associated injuries,
and time to fasciotomy were not predictive of complications. CONCLUSIONS:
Fasciotomy for trauma is most efficacious when performed early. However, when
performed late, it results in similar rates of limb salvage as compared with
early fasciotomy but at the increased risk of infection. These results support
aggressive use of fasciotomy in extremity trauma regardless of time of
diagnosis.

PMID: 9347868 [PubMed - indexed for MEDLINE]