An earthquake reality: fasciotomy wounds and treatments

Abstract

Earthquake-induced Crush Syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with Compartment Syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues.

Keywords

• Earthquake
• fasciotomy wounds
• negative pressure therapy (VAC)
• hyperbaric oxygen therapy

References

1. 1. Gresh M. Compartment syndrome in the pediatric patient. Pediatr Rev. 2017;38(12):560-565. doi: 10.1542/pir.2016-0114.
2. 2. Schmidt AH. Acute compartment syndrome. Injury. 2017;48:S22-S25. doi: 10.1016/j.injury.2017.04.024.
3. 3. Vaillancourt C, Shrier I, Vandal A, et al. Acute compartment syndrome: how long before muscle necrosis occurs? CJEM. 2004;6(3):147-154. doi:10.1017/s1481803500006837.
4. 4. Kakagia D, Karadimas E, Drosos G, Ververidis A, Trypsiannis G, Verettas D. Wound closure of leg fasciotomy: comparison of vacuum-assisted closure versus shoelace technique. A randomised study. Injury. 2014;45(5):890-893. doi: 10.1016/j.injury.2012.02.002.
5. 5. Heemskerk J, Kitslaar P. Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies. World J Surg. 2003;27(6):744-747. doi: 10.1007/s00268-003-6691-7.
6. 6. Jauregui JJ, Yarmis SJ, Tsai J, Onuoha KO, Illical E, Paulino CB. Fasciotomy closure techniques: A meta-analysis. Journal Orthop Surg. 2017;25(1):2309499016684724. doi: 10.1177/2309499016684724.
7. 7. Erek E, Sever MS, Serdengeçti K, , et al. An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant. 2002;17(1):33-40. doi: 10.1093/ndt/17.1.33.
8. 8. Kazancioglu R, Cagatay A, Calangu S, et al. The characteristics of infections in crush syndrome. Clin Microbiol Infect. 2002;8(4):202-206. doi: 10.1046/j.1469-0691.2002.00371.x.

9. 9. Dire DJ. Infection following wounds, bites and burns. Infectious Disease in Emergency Medicine. Philadelphia: Lippincott-Raven, 1998: pp. 231-260. doi: 10.1136/emj.20.3.251.
10. 10. Duman H, Kulahci Y, Sengezer M. Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J. 2003;20(3):251-252. doi: 10.1136/emj.20.3.251.
11. 11. Baharestani M, Amjad I, Bookout K, Fleck T, Gabriel A, Kaufman, D. V.A.C. Therapy in the management of paediatric wounds: clinical review and experience. Int Wound J. 2009;6:1-26. doi: 10.1111/j.1742-481X.2009.00607.x.
12. 12. Gabriel A, Heinrich C, Shores J, et al. Outcomes of vacuum-assisted closure for the treatment of wounds in a paediatric population: case series of 58 patients. J Plast Reconstr Aesthet Surg. 2009;62(11):1428-1436. doi: 10.1016/j.bjps.2008.06.033.
13. 13. Bussell HR, Aufdenblatten CA, Gruenenfelder C, Altermatt S, Tharakan SJ. Comparison of lower extremity fasciotomy wound closure techniques in children: vacuum-assisted closure device versus temporary synthetic skin replacement. Eur J Trauma Emerg Surg. 2019;45(5):809-814. doi: 10.1007/s00068-018-0985-9.
14. 14. King A, Stellar JJ, Blevins A, Shah KN. Dressings and Products in Pediatric Wound Care. Adv Wound Care (New Rochelle). 2014;1;3(4):324-334. doi: 10.1089/wound.2013.0477.
15. 15. Waisman D, Shupak A, Weisz G, Melamed Y. Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute. Pediatrics. 1998;102(5):E53. doi: 10.1542/peds.102.5.e53.
16. 16. Weiland DE. Fasciotomy closure using simultaneous vacuum-assisted closure and hyperbaric oxygen. Am Surg. 2007;73(3):261-266. doi: 10.1177/000313480707300313.