Management of Highly Exudative Faciotomy Wounds

Management of Highly Exudative Fasciotomy Wounds            Fasciotomies are created to prevent complications from compartment syndrome.  The wounds generally have no depth and have exposed muscle and tendon.  The wounds can be difficult to manage due to large amounts of drainage from edema in the lower extremity.    Treatment goals included drainage absorption and protection of  peri-wound skin from maceration.            LJ was a 42 year old post CABG.  She required going back to the OR for re-exploration and placement of an IABP.  (Intra Aortic Balloon Pump)  The foot distal to the IABP site later became cold and pulseless.  The IABP was immediately removed.  Continued complaints of weakness and difficulty walking prompted a vascular consult that revealed compartment syndrome.    She immediately was taken to the OR for lower leg fasciotomies and muscle debridement.  The wound and ostomy team was consulted for wound management.             The patient had medial and lateral fasciotomies.  Upon initial assessment, the patient had been soaking through multiple layers of absorptive dressings.  The peri-wound skin became macerated.  NPWT was initiated.  Muscle and tendon were protected with non-adherent dressing.  Flat JP type drains were used, and the two wounds were “Y” connected to one pump.  Protection of the peri-wound skin from maceration was accomplished by placement of transparent dressing around the wound edges prior to dressing application.              With drainage under control, the patient was able to participate in physical therapy without saturated dressings falling off.  The edema continued to decrease in the leg, and the patient was transferred to ECF to continue NPWT management and physical therapy.