The application effect of preventive fasciotomy decompression in the replantation of severed limbs
Objective To explore the application effect of preventive fasciotomy decompression in replantation of severed large limbs.Methods From December 2012 to December 2022,53 patients with large limb amputation were treated with replantation.The clinical data of patients were collected,including age,ischemic time,degree of shock,fracture plane,and skeletal and soft tissue damage.The mangled extremity security score(MESS)was evaluated.According to the dissociation plane and MESS score,they were divided into 4 groups,namely Group A with 11 cases(low dissociation,MESS＜9 group),Group B with 16 cases(low dissociation,MESS≥9 group),Group C with 15 cases(high dissociation,MESS＜9 group),and Group D with 11 cases(high dissociation,MESS ≥ 9 group).The independent sample t-test was used to analyze the effects of preventive fasciotomy decompression during replantation surgery on postoperative lactate(LA)and creatine kinase(CK)in four groups.The survival of the replanted limb was observed after surgery and the functional recovery of the replanted limb were followed up.Results During the replantation surgery,27 cases underwent prophylactic fasciotomy for decompression,while 26 cases did not undergo prophylactic fasciotomy for decompression.The preventive fasciotomy and decompression during replantation could reduce LA in the blood at the end of the surgery,but could not reduce the short-term blood CK in Group A,and the difference was not statistically significant(P＞0.05).It could reduce the blood CK levels in Group B,C and D on the third day after surgery,while also reduce the blood CK levels in Group D patients on the second day after surgery,with a statistically significant difference(P＜0.05).There were 2 cases of limb necrosis after replantation.51 patients who survived replantation were follow-up for 4 to 42 months postoperatively,with an average of 16.4 months.According to Chen Zhongwei's criteria for limb replantation,there were 7 excellent cases,27 good cases,14 fair cases,and 3 poor cases.Conclusion For patients with high dislocation,prophylactic fasciotomy and decompression during replantation can to some extent reduce the degree of postoperative muscle and soft tissue necrosis.For patients with low dislocation,if MESS≥9,preventive fasciotomy decompression during replantation is more effective.If MESS＜9,there is no need to perform preventive fasciotomy during the operation.The close observation after the operation is necessary to minimize the potential complications of excessive incision.
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