Closure Of Fasciotomy Wounds Research Articles

An earthquake reality: fasciotomy wounds and treatments

Earthquake-induced Crush Syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with Compartment Syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues.

Nylon cable ties–assisted delay primary closure of fasciotomy wound in patients of forearm compartment syndrome

Abstract Background Forearm compartment syndrome is a rare condition that requires forearm fasciotomy to release compartment pressure. In most cases, there is little to no skin damage initially, but after the fasciotomy, the skin flap may gradually retract. Traditional methods for reconstructing fasciotomy wounds, such as skin grafts or flaps, often result in an unpleasant appearance and require donor sites. Materials and Methods We present a method using nylon cable ties for delayed primary closure of forearm fasciotomy wounds. We retrospectively reviewed patients who underwent fasciotomy of forearms for compartment syndrome and nylon cable ties–assisted closure in a medical center from January 2017 to December 2022. Results Of the 7 eligible patients, 4 suffered from compartment syndrome of the forearm because of iatrogenic vascular rupture after procedures, whereas the other reasons included open-type fracture and fasciitis. For all the patients, nylon cable ties were applied for delayed primary wound closure after emergent fasciotomy. Six of them achieved successful wound closure by nylon cable ties without skin grafts or flaps on median day 12 (days 6–19). Only 1 patient required skin graft reconstruction after the application of nylon cable ties for 10 days. Conclusions Nylon cable ties, which are inexpensive and readily available, can be adjusted according to the different tension along the wound edges. They provide a simple, effective, and safe way to close difficult forearm fasciotomy wounds, which often result in a retracting skin flap after the procedure.

Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds: A Systematic Review.

A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported successin the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.

Closure of Fasciotomy Wound Using Dynamic Dermal Approximation Technique

Purpose: Compartment syndrome is a surgical emergency that is managed by a fasciotomy. However, it is associated with complications, including long hospital stay, wound infection and osteomyelitis need for further surgery for delayed wound closure or skin grafting, scarring, delayed bone healing, pain and nerve injury, permanent muscle weakness, chronic venous insufficiency, cosmetic problems, and an overall increased cost of care. A need for an early closure technique that will decrease all the above complications is described in this study. Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between from January 2020 to December 2022.This hospital-based study was done on compartment syndrome patients where fasciotomy was done and the wound closed by dynamic dermal suture approximation technique and results reviewed and outcome assessed. Results: The technique was applied to a total of 12 patients with compartment syndrome. Ten of twelve patients in study were compartment syndrome of upper limb since severe lower limb trauma patients were excluded in view of need for other procedures. The wounds were divided into three classes as post burn, post trauma and post contrast extravasation. Wound closure was achieved in 75 percent of total cases and all of six post contrast extravasation compartment syndrome patients. Conclusion: Following a fasciotomy, wound closure is a topic that is often controversial. The preference for one technique over another is influenced by the availability of resources, institutional familiarity, and clinical scenarios. Dynamic dermal approximation sutures can be applied with minimal risk to most uncomplicated fasciotomies. The benefits are minimal complication, the best cosmetic outcome, and low cost. However, patients with a high risk of complications may need other methods. Keywords: Compartment Syndrome, Fasciotomy, Wound Closure Techniques, Negative-Pressure Wound closure

Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients

BackgroundTibial plateau fractures with an ipsilateral compartment syndrome are a clinical challenge with limited guidance regarding the best time to perform open reduction and internal fixation (ORIF) relative to fasciotomy wound closure. This study aimed to determine if the risk of fracture-related infection (FRI) differs based on the timing of tibial plateau ORIF relative to closure of ipsilateral fasciotomy wounds. MethodsA retrospective cohort study identified patients with tibial plateau fractures and an ipsilateral compartment syndrome treated with 4-compartment fasciotomy at 22 US trauma centers from 2009 to 2019. The primary outcome measure was FRI requiring operative debridement after ORIF. The ORIF timing relative to fasciotomy closure was categorized as ORIF before, at the same time as, or after fasciotomy closure. Bayesian hierarchical regression models with a neutral prior were used to determine the association between timing of ORIF and infection. The posterior probability of treatment benefit for ORIF was also determined for the three timings of ORIF relative to fasciotomy closure. ResultsOf the 729 patients who underwent ORIF of their tibial plateau fracture, 143 (19.6%) subsequently developed a FRI requiring operative treatment. Patients sustaining infections were: 21.0% of those with ORIF before (43 of 205), 15.9% at the same time as (37 of 232), and 21.6% after fasciotomy wound closure (63 of 292). ORIF at the same time as fasciotomy closure demonstrated a 91% probability of being superior to before closure (RR, 0.75; 95% CrI, 0.38 to 1.10). ORIF after fasciotomy closure had a lower likelihood (45%) of a superior outcome than before closure (RR, 1.02; 95% CrI; 0.64 to 1.39). ConclusionData from this multicenter cohort confirms previous reports of a high FRI risk in patients with a tibial plateau fracture and ipsilateral compartment syndrome. Our results suggest that ORIF at the time of fasciotomy closure has the highest probability of treatment benefit, but that infection was common with all three timings of ORIF in this difficult clinical situation.

Shoe-Lace Technique Hasten Delayed Primary Closure In Fasciotomy Wound For Forearm Compartment Syndrome

We report a case of acute compartment syndrome of the forearm in a 51-year-old man with open fracture distal third radius (Gustilo I). Decompressive fasciotomy was performed promptly. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a shoe-lace technique: silastic vessel loop were interlaced held together with skin staplers placed at the edge of the fasciotomy wound and were then tightened daily. Delayed primary closure of the fasciotomy wound was performed after 8 days post fasciotomy with complete opposition of skin edges without tension. Shoelace closure is a good option for atraumatic fasciotomy wound closure with good cosmesis result.

Evaluating the Efficacy of Multilayered Light Compression Therapy in Fasciotomy Wound Closure in Patients Who Underwent Revascularization Procedures: A Case Series and Literature Review

Delayed primary closure is considered standard of care for patients undergoing lower extremity (LE) 4 compartment skin fasciotomies after revascularization for acute limb ischemia (ALI). At our institution, multilayer light compression therapy (MLCT) is used after failure of an initial attempt of delayed primary closure. To assess the efficacy of MLCT as an alternative for wound closure, this strategy was compared with historical controls from negative wound pressure therapy (NWPT). It was hypothesized that our system would be effective and of comparable performance to end points described in the literature and valuable for reducing complications, morbidity, and operational costs associated with other approaches.

Does the shoe-lace technique aid direct closure of fasciotomy wounds after acute compartment syndrome of the lower leg? A retrospective case-control study.

Background and objective:Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. Although the shoe-lace technique, where vessel loops are threaded in a crisscross fashion and tightened daily, has been widely used, no studies have compared the shoe-lace technique with the conventional one. The aim of this study was to compare the shoe-lace technique with the conventional technique.Methods:We identified 359 consecutive patients with intramedullary nailed tibia fracture and complete medical records including outpatient data between April 2007 and April 2015 from electronic patient database of our institute. The use of the shoe-lace technique was compared to conventional one (in which wounds were first left open with moist dressings). Main outcome measurement is direct closure of fasciotomy wounds.Results:From 359 consecutive patients with intramedullary nailed tibia fracture, fasciotomy was performed on 68 (19%) patients. Of these, the shoe-lace technique was used in 47 (69%) patients while in 21 (31%) patients, the shoe-lace technique was not applied. Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002).Conclusions:The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and thus reduces the frequency of free skin grafts. Our finding needs to be confirmed in a high-quality randomized controlled trial.

Utility of Shoelace Technique in Closure of Fasciotomy Wounds in Electric Burns.

Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST-7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST-7 days (range 6-10) as compared to Group C-20 days (range 12-48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.

Comparative study of delayed primary closure by shoelace technique versus conventional secondary suturing method in closure of fasciotomy wounds, done for spreading cellulitis with compartment syndrome

Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.

Dermotraction as a Simple and Effective Technique for Fasciotomy Wound Closure.

Background| Fasciotomy is the best treatment option of acute compartment syndrome, but it results into large wounds which are difficult to manage. Different techniques have been utilized to manage the fasciotomy wounds which have their respective merits and demerits. This study was conducted to evaluate yet another novel technique which requires skin stapler and Prolene #1 sutures. Methods| This descriptive cases series was done using non-probability convenient sampling technique from January 2015 and June 2017 at Department of Orthopedics Surgery, King Edward Medical University / Mayo Hospital, Lahore. We included 24 fasciotomy wounds. They were managed with Dermotraction technique. We excluded patients with vascular injury. All wounds were successfully closed within an average time of seven days. The procedure was found to be cost effective, easy to execute and with minimal complications. Results| Amongst the total 13 patients, all were males of age ranging from 14 to 45year with mean age of 28.46±9.97. Majority, 10 patients (77 %) had acute compartment syndrome of leg and each patient managed with two fasciotomy wounds (N= 20). All fasciotomy wounds were closed with serial traction technique and the average time of closure was 07 days ranging from 3 days to 17 days 8.61±2.63. Conclusion| We concluded from the study that dermotraction technique has good outcome in fasciotomy wound closer and healing and it is a cost effective.

Negative pressure wound therapy in modern orthopaedic practice

Negative pressure wound therapy (NPWT) is commonly used in orthopaedic practice. Biochemical and mechanical factors of NPWT optimize the local wound environment by increasing local angiogenesis, interleukin (IL)-8, and cell division to synergistically promote soft-tissue healing. Applications vary widely in orthopaedics. In trauma patients, it can temporize soft-tissue wounds in open fractures, aid in closure of fasciotomy wounds, and improve incorporation of skin grafts. Incisional vacuum therapy can maintain integrity of wound closure in high-risk patients and anatomic locations. When combined with instillation fluid, NPWT has the potential to treat infected tissue and deep hardware. Complications are avoidable but can include skin breakdown, wound contamination, and hemorrhage. Further research continues to clarify the role of NPWT in orthopaedic surgery.

Shoe lace technique, a simple and less expensive method for Fasciotomy wound closure following compartment syndrome

Introduction: Compartment syndrome is a common and severe medical condition that can lead to ischemia and ultimately tissue loss. The treatment of choice is emergent fasciotomy to lower the compartment pressure. However, closing fasciotomy wound often presents a problem because of edema and skin retraction. As a result, numerous techniques have been devised to optimize wound closure. AIM: To perform fasciotomy wound closure by shoe lace technique which is a type of dermal apposition technique for gradual primary closure of fasciotomy wound. Materials and Methods: The study included 19 patients who presented with compartment syndrome involving either upper or lower extremities due to various causes. Decompression fasciotomy was performed in all the cases to relieve compartment pressure. Shoe lace technique was performed for closure of wound. Patients demographics, location of fasciotomy, time duration between injury and fasciotomy, number of tightening session, time to primary closure, length of hospital stay, need for skin grafts and any complication if occurred during procedure were recorded. Results: Out of 19 patients 15 were males and 4 were females. Average age was 34.8 years. Lower extremity was involved in 14 cases. Fracture was the cause of compartment syndrome in 16 cases. Closure was obtained at an average of 3.5 tightening session. All the fasciotomy wounds were closed within an average of 8.3 days. Average duration of hospital stay was 12.3 days. No major complication was encountered in the study one case reported to have infection at wound site. Conclusion: Shoe lace technique is a simple and economical method for fasciotomy wound closure. It takes less time to closure, does not need a second procedure for closure thus reduces need of nursing care, hospital stay resulting in lower morbidity, healthcare cost and better aesthetic result.

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases

Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.

Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome

AimThe aim of this study was to investigate the effects of compartment syndrome and timing of fasciotomy wound closure on surgical site infection (SSI) after surgical fixation of tibial plateau fractures. Our primary hypothesis was that SSI rate is increased for fractures with compartment syndrome versus those without, even accounting for confounders associated with infection. Our secondary hypothesis was that infection rates are unrelated to timing of fasciotomy closure or fixation. Materials and methodsWe conducted a retrospective cohort study of operative tibial plateau fractures with ipsilateral compartment syndrome (n=71) treated with fasciotomy at our level I trauma center from 2003 through 2011. A control group consisted of 602 patients with 625 operatively treated tibial plateau fractures without diagnosis of compartment syndrome. The primary outcome measure was deep SSI after ORIF. ResultsFractures with compartment syndrome had a higher rate of SSI (25% versus 8%, p<0.001). The difference remained significant in our multivariate model (odds ratio, 7.27; 95% confidence interval, 3.8–13.9). Delay in timing of fasciotomy closure was associated with a 7% increase per day in odds of infection (95% confidence interval, 0.2–13; p<0.05). ConclusionsTibial plateau fractures with ipsilateral compartment syndrome have a significant increase in rates of SSI compared with those without compartment syndrome (p<0.001). Delays in fasciotomy wound closure were also associated with increased odds of SSI (p<0.05).

A comparison of fasciotomy wound closure methods following extremity compartment syndrome at a regional trauma centre

Background Extremity fasciotomy wound closure following acute compartment syndrome is often prohibited by residual swelling, producing wounds that significantly contribute to patient morbidity. The aim of this study was to assess patient and fasciotomy wound outcomes associated with dynamic closure (DYN), delayed primary closure (DPS) and split skin grafting (SSG) techniques.

The dermatotraction technique for closure of fasciotomy wound

Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible. This communication describes a technique that uses 1-0 prolene suture material, skin stapler and the natural stretching ability of the skin to enable primary closure of wounds. The technique described uses dermatotraction to stretch the skin, is a cost-effective way to achieve primary closure of large wounds with supplies that are readily available in every operating room.

A Case Series Study to Explore the Efficacy of Plastic Bands in Closure of Fasciotomy Wounds and Open Fracture II, IIIA, IIIB: A Dynamic Wound Closure

Background: The care of compartment syndrome fasciotomy & open fracture II, IIIA & IIIB wounds begin with preoperative planning. The ultimate goal is to prevent infection & facilitate healing. This study explores the use of plastic bands in closing fasciotomy wounds & open fracture. Methods: The time to definite closure, complications, need for additional intervention, length of hospital stay and daily treatment cost in 10 patients were evaluated. Five patients with fasciotomy wounds & five patients with open fractures treated with plastic bands for wound closure were evaluated. Result: All fasciotomy wounds & open fracture wounds in 10 patients closed successfully within 5 – 10 days. Only one patient developed minimal complication. A significant reduction in hospital stay, faster wound closure and lower daily treatment cost was observed.

Fasciotomy Wound Management and Closure—Updated

Fasciotomy Wound Management and Closure—Updated

Fasciotomy Wound Management and Closure

While although full-compartment fasciotomy is unquestionably the best treatment for acute compartment syndrome, it is not a benign procedure. It leaves a large open wound that should be left open for at least 2 to 3 days. The outward pressure from swollen muscle and skin retraction serves to increase the dimensions of these wounds, which makes delayed primary closure challenging and often not possible in the most common fasciotomy site—the leg. This study discusses recent advances in the management of fasciotomy wounds that can reduce the morbidity of this procedure. Negative pressure wound therapy and dermatotraction are 2 important innovations, which improve overall outcomes.