Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure?
Summary:. Based on the findings of two consecutive cases of upper extremity compartment syndrome encountered at our institution, we hypothesize that the presence of compartment syndrome in the unstable COVID-19 patient may be associated with high mortality and low limb salvage rates. A literature se...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-07-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004454 |
| _version_ | 1817977620040515584 |
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| author | Stephanie W. Holzmer, MD Catherine A. Walsh, MD Waseem Mohiuddin, MD Frances E. Sharpe, MD |
| author_facet | Stephanie W. Holzmer, MD Catherine A. Walsh, MD Waseem Mohiuddin, MD Frances E. Sharpe, MD |
| author_sort | Stephanie W. Holzmer, MD |
| collection | DOAJ |
| description | Summary:. Based on the findings of two consecutive cases of upper extremity compartment syndrome encountered at our institution, we hypothesize that the presence of compartment syndrome in the unstable COVID-19 patient may be associated with high mortality and low limb salvage rates. A literature search was conducted with key search terms, including “compartment syndrome, fasciotomy, COVID, and coronavirus.” Articles describing patients with a confirmed COVID-19 diagnosis who developed extremity compartment syndrome were included in our study. The primary outcome investigated was patient survival. Secondary outcomes included limb survival and limb salvage. Limb salvage was calculated in patients who survived to time of discharge, whereas limb survival was counted for all patients. We then added our two cases to the findings reported in our literature to determine current overall limb salvage and patient survival rates. Our review of the literature yielded six case reports of ten extremities that developed compartment syndrome in the COVID-19 positive patient. Overall survival was four of six patients (67%). The overall limb survival rate at the time of hospital discharge was three of 10 (30%). With the addition of our two cases, overall survival was four of eight (50%) and overall limb survival rate was three of 12 (25%). Furthermore, with inclusion of our two cases, the patient survival rate of hemodynamically unstable patients was only three of seven (43%). The development of compartment syndrome in the unstable COVID-19 patient may be a harbinger of death, and the decision to proceed with operative intervention is challenging, complex, and in some cases must prioritize life over limb. |
| first_indexed | 2024-04-13T22:18:44Z |
| format | Article |
| id | doaj.art-e56ab870d9134d929a1bedf69c07c502 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-13T22:18:44Z |
| publishDate | 2022-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-e56ab870d9134d929a1bedf69c07c5022022-12-22T02:27:22ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-07-01107e445410.1097/GOX.0000000000004454202207000-00018Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure?Stephanie W. Holzmer, MD0Catherine A. Walsh, MD1Waseem Mohiuddin, MD2Frances E. Sharpe, MD3From the * Department of Plastic and Reconstructive Surgery, Loma Linda University, Loma Linda, Calif.† Department of Plastic Surgery, Kaiser Permanente Southern California, Ontario, Calif.From the * Department of Plastic and Reconstructive Surgery, Loma Linda University, Loma Linda, Calif.‡ Department of Orthopedic Surgery, Kaiser Permanente Southern California, Fontana, Calif.Summary:. Based on the findings of two consecutive cases of upper extremity compartment syndrome encountered at our institution, we hypothesize that the presence of compartment syndrome in the unstable COVID-19 patient may be associated with high mortality and low limb salvage rates. A literature search was conducted with key search terms, including “compartment syndrome, fasciotomy, COVID, and coronavirus.” Articles describing patients with a confirmed COVID-19 diagnosis who developed extremity compartment syndrome were included in our study. The primary outcome investigated was patient survival. Secondary outcomes included limb survival and limb salvage. Limb salvage was calculated in patients who survived to time of discharge, whereas limb survival was counted for all patients. We then added our two cases to the findings reported in our literature to determine current overall limb salvage and patient survival rates. Our review of the literature yielded six case reports of ten extremities that developed compartment syndrome in the COVID-19 positive patient. Overall survival was four of six patients (67%). The overall limb survival rate at the time of hospital discharge was three of 10 (30%). With the addition of our two cases, overall survival was four of eight (50%) and overall limb survival rate was three of 12 (25%). Furthermore, with inclusion of our two cases, the patient survival rate of hemodynamically unstable patients was only three of seven (43%). The development of compartment syndrome in the unstable COVID-19 patient may be a harbinger of death, and the decision to proceed with operative intervention is challenging, complex, and in some cases must prioritize life over limb.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004454 |
| spellingShingle | Stephanie W. Holzmer, MD Catherine A. Walsh, MD Waseem Mohiuddin, MD Frances E. Sharpe, MD Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? Plastic and Reconstructive Surgery, Global Open |
| title | Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? |
| title_full | Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? |
| title_fullStr | Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? |
| title_full_unstemmed | Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? |
| title_short | Limb Fasciotomy for COVID-19 Patients: Is the Chance to Cut a Chance to Cure? |
| title_sort | limb fasciotomy for covid 19 patients is the chance to cut a chance to cure |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004454 |
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