Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot.

BACKGROUND: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression.

METHODS: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies.

RESULTS: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005).

CONCLUSION: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments.

CLINICAL RELEVANCE: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.