(CS-090) Under Pressure and All Broken up: Managing Compartment Syndrome wounds in the presence of major rearfoot fractures.
Co-Author(s):
Deepali Darji, DPM AACFAS – Northern Illinois Foot and Ankle Specialists; Patrick McEneaney, DPM, AAPWCA, FACFAS – Northern Illinois Foot and Ankle Specialists; Joseph Rundell, DPM – Northern Illinois Foot and Ankle Specialists
Introduction: Wounds from fasciotomies to address compartment syndrome present difficulty for clinicians due to the soft tissue compromise from the traumatic event and the compartment syndrome disease process. There is sparse literature to guide clinicians on this issue. Additionally surgical intervention is often needed to treat the concominant fractures which pose further difficulty in these wounds given surgical trauma and possible need for implants. It is our hope to present this case to guide clinicians in the management of these challenging wounds.
Methods: A 22 year old male presented to the ED S/P extensive foot trauma due to high speed MVA. Multiple forefoot fractures were identified as well as a talus fracture. Additionally compartment syndrome was confirmed using the wick catheter. Emergent fasciotomy was performed. Staged reconstruction of the soft tissue was performed using NPWT wound therapy and skin substitute placement to optimize the soft tissue to allow for healing and addressing underlying fractures
Results: After NPWT and skin substitute placement the wounds were restored to allow for closure which allowed for open treatment of the multiple fractures. The patient ultimately healed these complicated wounds without issue.
Discussion: Addressing wounds associated with fasciotomy to manage compartment syndrome are challenging due to the local wound environment as well as sparse guidance from literature. In this case we discuss the successful management of fasciotomy surgical wounds by a staged approach to optimize the soft tissue envelope to allow for aggressive early resolution as secondary healing was not an option given the need to treat the concominant fractures. By presenting this case we hope to guide clinicians who may be facing such challenging wounds.