"Infection rates and complications following fasciotomy in mass casualty events: Lessons learned from the 2023 Turkey-Syria earthquake"

Abstract

Background: This study aimed to investigate the outcomes of fasciotomy, including infection, amputation, and complications, in patients with crush injuries from the 2023 Turkey-Syria earthquake.

Material and methods: Out of 210 patients presenting from the earthquake zone, 46 patients (23 male-23 female, mean age: 21 years) who underwent 52 extremity fasciotomies were included. Data collected included infection rates, need for grafts/flaps, amputation rates, creatinine, CK levels, need for dialysis, and neurologic injuries. Early fasciotomy was defined as ≤12 h and late as >12 h after the earthquake. Patients were categorized by fasciotomy timing and location (earthquake-zone or university hospital). Time to first debridement was also evaluated.

Results: The median time to fasciotomy was 24 h (2-97 h, (IQR 12.5-65)). Fasciotomies performed in the earthquake zone had a higher infection rate (68 % vs. 25 %, p = 0.061), though this difference was not statistically significant, likely due to the small sample size. There was no significant difference in infection rates between patients who underwent early fasciotomy (8/13, 62 %) and those who underwent late fasciotomy (20/33, 61 %) (p = 1.0).Amputation was required in 7/46 patients (15 %), with 1/13 patient (8 %) in the early fasciotomy group and 6/33 patients (18 %) in the late fasciotomy group (p = 0.698). Skin grafting was performed for wound closure in 19 patients (42 %). In patients undergoing early fasciotomy, 75 % (9/12) required skin grafts for wound closure, whereas the rate in the late fasciotomy group was significantly lower at 30 % (10/33) (p = 0.019). The mean time to first debridement was significantly higher in infected patients [65.5 (SD 11.8) vs 57.8 (SD 11.4 h), p = 0034]. For wounds that required skin grafts, the average duration between the fasciotomy and initial debridement was significantly higher (68.5 vs 54 h), p = 0.001.

Conclusion: Fasciotomies performed in earthquake zones had higher infection rates compared to hospitals, though not statistically significant. Infections with potentially multi-drug resistant bacterias may increase the risk of complications like amputations. Timely debridement and efficient patient transfer remain essential to minimizing risks and improving outcomes.

Keywords: Amputation; Compartment syndrome; Earthquake; Fasciotomy; Infection Rates; Mass casualty.