A 6-Year Cohort Study Assessing Outcomes Following Calf Fasciotomies at a Single Tertiary Vascular Trauma Centre

Abstract Introduction Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared outcomes following prophylactic (Group1) versus therapeutic calf fasciotomies (Group2), as well as early (within 6 hours) versus delayed fasciotomies (>6 hours) at a single tertiary vascular trauma centre. Methods All patients undergoing calf fasciotomies between 1st January 2017 and 31st November 2022 were identified from a prospectively collected vascular departmental database. The primary outcomes included foot drop, amputation and mortality while infection, wound debridement, neuropathic pain and negative-pressure dressing were secondary outcomes. Statistical analysis with SPSS was performed using Fisher's exact test. Results 88 patients (65 men, 23 women) of median age (IQR) 67 (56-74) underwent calf fasciotomies. Of these, 43 (48.9%) were therapeutic (Median age=62) and 45 (51.1%) were prophylactic (Median age=67).Ischaemia was more prevalent among Group1 while trauma among Group2.There were no significant differences among outcomes between both groups apart from higher 30-day mortality rate (26.7% vs. 7.0%, p=0.014)and incidence of neuropathic pain (22.2% vs. 4.7%, p=0.027)in Group1 versus Group2.Most patients (79.5%) underwent early calf fasciotomy with no significant differences in primary and secondary outcomes between early and delayed fasciotomy groups. The delay was attributed to theatre unavailability (n=6) and on-going resuscitation (n=5). Conclusion Higher rates of neuropathic pain and 30-day mortality in group1 may be attributed to co-existing lower limb ischaemia. Further work is required to establish the impact of neuropathic pain. Pathways should be developed to ensure rapid access to theatres for patients with suspected ACS.