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1.
Shackford  SFRich  NHFeliciano  DVedMoore  EEedMattox  KEed Peripheral vascular injury.  Trauma. 3rd ed Stamford, Conn Appleton-Lange1996;819- 851Google Scholar
2.
Feliciano  DVCruse  PASpjut-Patrinely  V  et al.  Fasciotomy after trauma to the extremities.  Am J Surg. 1988;156533- 536Google ScholarCrossref
3.
Field  CKSenkowsky  JHollier  LH  et al.  Fasciotomy in vascular trauma: is it too much, too often?  Am Surg. 1994;60409- 411Google Scholar
4.
Rosfors  SBygdeman  SWallensten  R Venous circulation after fasciotomy of the lower leg in man.  Clin Physiol. 1988;8171- 179Google ScholarCrossref
5.
Araki  CTBack  TLPadberg  FT  et al.  The significance of calf muscle pump function in venous ulceration.  J Vasc Surg. 1994;20872- 879Google ScholarCrossref
6.
Aita  DJKvamme  PRice  JC  et al.  Venous insufficiency: a later sequelae of four-compartment fasciotomy in the lower extremity.  Am Surg. 1993;59574- 577Google Scholar
7.
Ris  HBFurrer  MStronsky  S  et al.  Four-compartment fasciotomy and venous calf-pump function: long-term results.  Surgery. 1993;11355- 58Google Scholar
8.
Bermudez  KNelken  NKnudson  MM  et al.  Long-term results of lower extremity venous injuries.  Arch Surg. 1997;132963- 968Google ScholarCrossref
9.
Mubarak  SJOwen  CA Double-incision fasciotomy of the leg for decompression in compartment syndromes.  J Bone Joint Surg Am. 1977;50184- 187Google Scholar
10.
Christopoulos  DGNicolaides  ANSzendro  G  et al.  Air plethysmography and the effect of elastic compression on venous hemodynamics.  J Vasc Surg. 1987;5148- 159Google ScholarCrossref
11.
Esses  GEBandyk  DFCameron  JLed Diagnosis of venous insufficiency.  Current Surgical Therapy. Chicago, Ill Mosby– Year Book1995;749- 753Google Scholar
12.
Christopoulos  DNicolaides  ANSzendro  G Venous reflux: quantification and correlation with the clinical severity of chronic venous disease.  Br J Surg. 1988;75352- 356Google ScholarCrossref
13.
Christopoulos  DNicolaides  AN Noninvasive diagnosis and quantitation of popliteal reflux in the swollen and ulcerated leg.  J Cardiovasc Surg. 1988;29535- 539Google Scholar
14.
Porter  JMRutherford  RBClagett  GP  et al.  Reporting standards in venous disease.  J Vasc Surg. 1988;8172- 181Google ScholarCrossref
15.
Ernst  CB Fasciotomy in perspective.  J Vasc Surg. 1989;9829- 830Google ScholarCrossref
16.
Von Volkmann  R Verletzungenund and Krannkheitzen der Bewegunsorgane.  Handbuch der Allgemeinen und Speziellen Chirurgie. Vol 2 Erlangen, Germany F Enke Erlangen1872; (part 2) 234- 920Google Scholar
17.
Sumner  DSRutherford  RBed Hemodynamics and pathophysiology of venous disease.  Vascular Surgery. 3rd ed. Philadelphia, Pa WB Saunders Co1989;1483- 1504Google Scholar
18.
O'Donnell  TFRutherford  RBed Clinical diagnosis and classification of chronic venous insufficiency.  Vascular Surgery. 3rd ed. Philadelphia, Pa WB Saunders Co1989;1504- 1512Google Scholar
19.
Christopoulos  DNicolaides  ANCook  A  et al.  Pathogenesis of venous ulceration in relation to the calf muscle pump function.  Surgery. 1989;106829- 835Google Scholar
20.
Christopoulos  DNicolaides  ANGalloway  JMD Objective noninvasive evaluation of venous surgical results.  J Vasc Surg. 1988;8683- 687Google ScholarCrossref
21.
Garfin  SRTipton  CMMubarek  SJ  et al.  Role of fascia in maintenance of muscle tension and pressure.  J Appl Physiol. 1981;51317- 320Google Scholar
22.
Renz  BMFeliciano  DV Unnecessary laparotomies for trauma: a prospective study of morbidity.  J Trauma. 1995;38350- 356Google ScholarCrossref
Original Article
December 1998

Fasciotomy, Chronic Venous Insufficiency, and the Calf Muscle Pump

Author Affiliations

From the Department of Surgery, University of California, San Francisco, San Francisco General Hospital.

Arch Surg. 1998;133(12):1356-1361. doi:10.1001/archsurg.133.12.1356
Abstract

Objective  To test the hypothesis that fasciotomy may impair the function of the calf muscle pump, which in turn could result in the development of chronic venous insufficiency.

Design  A cohort study of patients with a history of lower extremity fasciotomy.

Setting  An urban trauma center.

Patients  Seventeen of the 83 patients identified through trauma, vascular, and/or orthopedic registries consented to participation in this study.

Interventions  Participating patients completed a study questionnaire, and then underwent a complete vascular examination, including air plethysmographic (APG) assessment. Patients with a history of venous injuries were also studied with color flow duplex venous imaging.

Main Outcome Measures  Function of the calf muscle pump as measured by APG, and evidence of chronic venous insufficiency as measured by APG, findings on clinical examination, and by venous ultrasonography.

Results  Seventeen patients completed the study, including 8 with a history of vascular injuries, 6 with old fractures, and 3 who had undergone fasciotomy for soft tissue infections. The time from injury to examination ranged from 5 months to 20 years. Eight patients had signs or symptoms of venous insufficiency, the severity of which appeared to be time dependent. The APG data showed significant mean differences between fasciotomy and control extremities in ejection fraction (P<.001) and residual volume fraction (P<.001), both measures of calf muscle pump function. There were no significant changes in venous filling index, a measure of venous reflux, or in outflow fraction, which correlates with venous obstruction. There were no differences in APG variables between patients with vascular injuries vs those with orthopedic or soft tissue injuries.

Conclusions  Lower extremity fasciotomy impairs long-term calf muscle pump function, as measured by APG, in patients with and without vascular injuries. These patients are at risk for the long-term development of chronic venous insufficiency following lower extremity trauma.

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