Session I - Tibia

Vacuum-Assisted Closure for Fasciotomy Wounds after Compartment Syndrome of the Leg

David Chang, MD; J. Castle; Lawrence X. Webb, MD, Wake Forest University School of Medicine, Winston-Salem, NC

Purpose: We evaluated the efficacy of vacuum-assisted closure (VAC) in the setting of compartment syndrome after fasciotomy.

Methods: We studied the records of a consecutive series of 34 patients who had compartment syndrome of the leg requiring a two-incision release of all four compartments and application of VAC until the time of definitive wound closure or coverage. A matched series of 34 consecutively antecedent patients with the same entry criteria except for the use of the VAC were also studied and served as a control group. The main parameter of interest was the time to definitive closure (or skin graft coverage) of the wounds.

Results: Of the 68 wounds in 34 patents managed with VAC, the average time to definitive closure or coverage for both the lateral and the medial wound was 6.7 days. For the 70 wounds in the 34 control patients, the average time to definitive closure or coverage was 16.1 days. This difference in time to wound closure between the VAC group and the non-VAC group was significant (P <0.05).

Discussion: Vacuum treatment for compartment syndrome of the leg after fasciotomy theoretically helps to speed the resolution of the swelling and tissue edema that are often components of this clinical entity. Experimental work has shown vacuum-assisted wound management to be effective in hastening the resolution of wound edema, enhancing local blood flow, promoting granulation tissue, and thwarting bacterial colonization. These factors may account for its utility in the management of fasciotomy wounds in the setting of compartment syndrome of the leg.