Fasciotomy in crush syndrome patients: debates continue
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan; l4321ms2.hinet.net
We read, with interest, the well written articles on fasciotomy and crush injury by Duman et al1 and Demirkiran et al.2 Demirkiran et al presented 18 cases of crush syndrome, seven of them underwent fasciotomy, and six of them had amputation in the end.2 It is difficult for Demirkiran et al2 to recommend fasciotomy as the first choice treatment in crush syndrome patients. By contrast, Duman et al1 presented 16 cases of fasciotomy, 10 of them had no peripheral pulses, four underwent amputation, four needed further physiotherapy, and eight functionally recovered after 15 months. Huang et al also reported high infection and amputation rate from their fasciotomies series.3 During an earthquake disaster because of increased patient overload and the chaotic situation, fasciotomies carry a higher risk of infection and can result in improper wound care and sepsis and mortality. Sever et al reported findings that support the attitude not to undertake fasciotomy unless clear objective indications are present such as increased intracompartmental pressure.4 Sever et al also suggested that the practice they followed during this disaster regarding fasciotomy was not correct.4 However, this dispute regarding fasciotomy is still not settled, and there is a need for prospective studies on intracompartmental pressure in crush syndrome patients.3
