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Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model

Wilkin, Geoffrey MD; Khogali, Shiemaa MSc; Garbedian, Shawn MD, FRCSC; Slagel, Bradley MD, FRCSC; Blais, Simon MD; Gofton, Wade MD, MEd, FRCSC; Liew, Allan MD, FRCSC; Renaud, Jean-Marc PhD; Papp, Steven MD, MSc, FRCSC

Journal of Bone & Joint Surgery - American Volume: 20 August 2014 - Volume 96 - Issue 16 - p 1378–1385
doi: 10.2106/JBJS.M.01010
Scientific Articles
Disclosures

Background: Negative-pressure wound therapy (NPWT) can improve fasciotomy wound closure, but its effects on skeletal muscle are largely unknown. The purpose of this study was to evaluate NPWT effects on skeletal muscle after fasciotomy for compartment syndrome in an animal model and to assess regional variability in muscle fiber regeneration.

Methods: Compartment syndrome was induced in the hindlimb of twenty-two adult female pigs with use of a continuous intracompartmental serum-infusion model. Fasciotomy was performed after six hours, and animals were randomized to receive either wet-to-dry gauze dressings (control group) or NPWT dressings (−125 mm Hg, continuous suction) for seven days. Delayed primary wound closure was attempted at seven days, and the peroneus tertius was harvested for analysis seven days or twenty-one days after fasciotomy. Muscles were weighed, and hematoxylin and eosin-stained samples from four regions of the muscle (superficial central, deep central, lateral, and proximal) were mapped for different cellular morphologies.

Results: Muscle weight was greater in the affected limb at all time points with no difference between treatment groups. At seven days, only the deep central samples in the NPWT group had a significantly greater cross-sectional area containing normal fibers as compared with that found in the controls. By twenty-one days, the deep central, lateral, and proximal regions of the NPWT-treated muscles had a smaller cross-sectional area containing normal fiber morphology and a greater cross-sectional area containing only mononucleated cells as compared with the controls.

Conclusions: NPWT did not decrease muscle weight. At twenty-one days, the extent of muscle fiber regeneration after fasciotomy for compartment syndrome was reduced in muscles treated with NPWT for seven days compared with the values in the control group treated with wet-to-dry gauze dressings.

Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.

1Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin: geoff.wilkin@gmail.com

2Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada

3Division of Orthopaedic Surgery, North York General Hospital, 4001 Leslie Street, Toronto, ON M2K 1E1, Canada

4Division of Orthopaedic Surgery, Sault Area Hospital, 240 McNabb Street, Sault Ste. Marie, ON P6B 1Y5, Canada

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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