Title : Rational application and therapeutic efficacy of prophylactic fasciotomy in major limb replantation procedures
Abstract:
Study Design: A retrospective study
Background: Compartment Syndrome (CS) is a serious complication following major limb replantation. However, the role of Prophylactic Fasciotomy (PF) in this context remains controversial. This study aims to establish a selective PF protocol by designing a scoring scale to guide its application in replantation surgery.
Methods: We retrospectively analyzed patients who underwent major limb replantation in our hospital between January 2013 and August 2023. Comparisons were made between the Prophylactic Fasciotomy Group (PFG) and the Non-PF Group (NPFG). PF scoring system was developed based on the identified differential factors between clinical groups. The scale’s efficacy was evaluated across different score intervals.
Results: The limb survival rate was 94.6% (70/74). Significant differences were observed between PFG and UPFG in amputation level, ischemic time, injury mechanism, combined injuries, and admission Creatine Kinase (CK) levels. The PF scoring system as follows:
- Amputation level: 0–4 (5 tiers, proximal to distal).
- Ischemic time: 0–3 (4 tiers, <4 to ≥8 hours).
- Injury mechanism: 0 (sharp) or 1 (blunt).
- Combined injuries: 0–4 (Tscherne classification).
- CK levels: 0–4 (<200 to ≥5000 U/L).
PFG patients predominantly scored ≥6, while NPFG scored ≤5. In the 2–5 interval, PF increased infection risk without improving outcomes. For scores 6–9, PF reduced muscle damage without elevating complications. All patients scoring ≥10 received PF.
Conclusions: PF is recommended for scores ≥6 due to its protective effect on muscle tissue and manageable complications. For scores ≤5, PF offers limited benefits and increases infection risk. The PF scale provides a clinical reference but requires validation in larger cohorts.
Keywords: Limb Replantation, Amputation, Fasciotomy, Ischemia-Reperfusion, Compartment Syndrome
