Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
Acute
compartment syndrome is a limb-threatening condition. As pressure rises
inside a muscle fascial compartment, capillary perfusion pressure falls
and causes cellular hypoxia. Untreated, the cascade of hypoxia,
microvascular dysfunction, and increased capillary permeability results
in irreversible ischemic injury. Prompt fasciotomy is the ideal
treatment. Many patients who undergo fasciotomy require delayed
skin-grafting and have long-term functional impairment1.
Recently,
negative-pressure wound therapy (NPWT) has been used on fasciotomy
wounds. The results of this practice are variable. Some authors have
reported decreased wound size2 and a shorter time to wound closure3, but a recent randomized controlled trial showed a longer time to wound closure and an increased need for skin grafts with NPWT4.
To
our knowledge, no one has examined NPWT effects on the underlying
skeletal muscle. NPWT increases microvascular circulation around the
wound5-8,
and this may be beneficial after ischemia. We assessed NPWT effects on
skeletal muscle cellular morphology at different time points after
compartment syndrome in an animal model and attempted to determine
whether regional differences in fiber recovery occurred. The primary
outcome that we investigated was the cross-sectional area occupied by
normal-appearing muscle fibers and other cellular morphologies. A
secondary outcome was the change in muscle weight as a marker of
intramuscular fluid accumulation. We hypothesized that NPWT would
improve muscle fiber regeneration after an acute compartment syndrome
and would decrease muscle weight by enhancing edema clearance.
La bibliografia pot ser interessant x si heu de presentar algun cas tractat amb aquest tipus de cura oclusiva-aspirativa
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