Fasciotomy Wounds Research Articles

Elevation as a treatment for fasciotomy wound closure

Elevation as a treatment for fasciotomy wound closure

Shoelace wound closure for the management of fracture-related fasciotomy wounds.

Background. Compartment syndrome is a serious complication that might occur following fractures. The treatment of choice is emergent fasciotomy of all the involved muscle compartments to lower the compartment pressure. The classic management of fasciotomy wounds was split thickness skin graft. Patients and Methods. Seventeen patients with fracture-related compartment syndrome were managed by fasciotomy in the Orthopaedic Casualty Unit of our university hospital. The fractures included four femoral fractures and 13 fractures of the tibia and fibula. Results. All fasciotomy wounds healed eventually. Wound closure occurred from the corners inward. The skin closure was obtained at an overall average of 4.2 tightening sessions (range 3–7). Fracture healing occurred at an average of 15.4 weeks (range 12 to 22 weeks). No major complications were encountered in this series. Conclusion. Closure of fasciotomy wounds by dermatotraction could be performed in a staged fashion, using inexpensive equipment readily available in any standard operating room, until skin was approximated enough to heal either through delayed primary closure or secondary healing.

Assisted closure of fasciotomy wounds

IntroductionNegative pressure wound therapy (NPWT) and vessel loop assisted closure are two common methods used to assist with the closure of fasciotomy wounds. This retrospective review compares these two methods using a primary outcome measurement of skin graft requirement.MethodsA retrospective search was performed to identify patients who underwent fasciotomy at our institution. Patient demographics, location of the fasciotomy, type of assisted closure, injury characteristics, need for skin graft, length of stay and evidence of infection within 90 days were recorded.ResultsA total of 56 patients met the inclusion criteria. Of these, 49 underwent vessel loop closure and seven underwent NPWT assisted closure. Patients who underwent NPWT assisted closure were at higher risk for requiring skin grafting than patients who underwent vessel loop closure, with an odds ratio of 5.9 (95% confidence interval 1.11 to 31.24). There was no difference in the rate of infection or length of stay between the two groups. Demographic factors such as age, gender, fracture mechanism, location of fasciotomy and presence of open fracture were not predictive of the need for skin grafting.ConclusionThis retrospective descriptive case series demonstrates an increased risk of skin grafting in patients who underwent fasciotomy and were treated with NPWT assisted wound closure. In our series, vessel loop closure was protective against the need for skin grafting. Due to the small sample size in the NPWT group, caution should be taken when generalising these results. Further research is needed to determine if NPWT assisted closure of fasciotomy wounds truly leads to an increased requirement for skin grafting, or if the vascular injury is the main risk factor.

Fasciotomy Wound Management and Closure

Fasciotomy Wound Management and Closure

Wound closure of leg fasciotomy: Comparison of vacuum-assisted closure versus shoelace technique. A randomised study

BackgroundFasciotomies, though essential for the prevention and management of compartment syndromes, may increase morbidity and prolong hospitalisation. Two widely applied methods of delayed primary closure are compared in leg fasciotomy wounds. Patients and methodsTwo groups, each of 25 patients with leg fasciotomies due to fractures and soft tissue injuries, who were randomly assigned to be treated either by vacuum assisted closure (VAC®, n=42 wounds, group V) or by the shoelace technique (n=40 wounds, group S), were evaluated in this study. Wound length, time to definite closure, complications, need for additional interventions and daily treatment costs were data collected and statistically assessed. ResultsWound closure time was significantly higher in group V compared to group S (p=0.001; 95% CI of the difference, 1.8–6.3 days).Five group V patients required split thickness skin grafts. In six group S patients, the vessel loops had to be replaced.The mean daily cost of negative pressure therapy alone was 135 euro (range 117–144 euro), whilst the mean daily cost of treatment for the shoelace technique was 14 euro ranging from 8 to 18 euro (p=<0.001). ConclusionsBoth VAC® and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. VAC® requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

The use of a silicon sheet for gradual wound closure after fasciotomy

We present a silicon sheet for temporary wound covering and gradual wound closure after open fasciotomy. Fasciotomy was performed in a total of 70 limbs with compartment syndrome (CS). The main etiology of CS was predominantly vascular. All patients were treated with a silicon sheet to cover the soft tissue defect and gradually reapproximate the skin margins. In 53% of the patients, a delayed final wound closure was achieved after a mean of 11.9 days. This method allows final closure of fasciotomy wounds without scar contractures, marginal necrosis, infection, or significant pain.

Delayed Primary Closure of Open Double Fasciotomy Wounds at Leg with “Pasha Device†A Novel Method

Objective: The objective of this study was to close open fasciotomy wounds using a new external fixation device. The principal behind this new development was based on dermotraction and Ilizarov traction regeneration technique.

Management of Fasciotomy Wounds-Does the Dressing Matter?

Fasciotomy is a limb-saving procedure in the management of ischemic extremities. Little evidence exists as to the best method of fasciotomy wound management. We hypothesized that the use of vacuum dressing (VAC) or creation of dynamic tension (DYN) would increase rates of primary closure, reducing the need for split thickness skin grafting (STSG). The records of a large urban Level I trauma center were used to identify fasciotomy recipients over a 10-year period and were retrospectively analyzed. Data collected included injury characteristics, wound management, and outcomes. Wound management was dictated by surgeon preference, and categorized as gauze packing, DYN, or VAC. The primary outcome was primary closure versus need for STSG. Wound management cohorts were compared using logistic regression. Fisher's exact test and χ(2) were performed to compare proportions and categorical variables respectively. From 2000 to 2009, 227 patients had a fasciotomy performed. Mechanism, age, and incidence of fracture were different between the groups. There was a trend towards increased primary closure with DYN (83%). Average length of stay (LOS) was 21 days for those receiving primary closure and 27 days for STSG. There was a significant decrease in LOS for the DYN group (average 16 days) when compared with gauze packing and VAC. In this series of 227 patients who underwent fasciotomy, no technique of wound management produced a significant improvement in primary closure rate. A trend toward more primary closure was seen in the DYN group. LOS was longer for patients receiving STSG. The DYN cohort had a significantly shorter LOS.

The Impact of Compartment Syndrome on Hospital Length of Stay and Charges Among Adult Patients Admitted With a Fracture of the Tibia

To compare hospital charges and length of stay in a series of adult patients with isolated, otherwise uncomplicated tibia fractures with and without acute compartment syndrome (ACS). Retrospective case-control study. Urban Level I trauma center. Forty-six previously healthy adults with isolated tibia fractures (open or closed), with or without ACS but without other complication, associated injury, or social circumstance that influenced hospital stay or charges. Intramedullary nailing in all patients with immediate fasciotomy and delayed fasciotomy closure in the subset of patients who developed ACS. Hospital length of stay in days and hospital charges. Forty-six otherwise uncomplicated patients with isolated tibial shaft fractures were identified. Twelve fractures were open. ACS occurred in five patients, all with closed fractures. In 41 patients without ACS (12 open fractures, 29 closed fractures), the mean hospital stay was 3.0 days and mean hospital charges were $23,800. The five patients with ACS underwent a mean of 1.6 additional surgeries to treat the fasciotomy wound, were hospitalized for a mean of 9.0 days, and the mean hospital charges were $49,700. These differences were highly significant for hospital stay (P < 0.005) and charges (P < 0.00004). In contrast, there were no differences in length of stay or hospital charges in patients with closed or open fractures, respectively. The cost of ACS is significant, resulting in hospital stays that are increased threefold and hospital charges that are more than doubled in this cohort of patients. The impact of compartment syndrome on these factors was more important than whether the fracture was open or closed. In addition to the obvious benefit to the patient, methods that decrease the incidence of compartment syndrome and need for fasciotomy such as improved diagnosis to prevent unnecessary fasciotomy and methods to reduce intramuscular pressure and avoid fasciotomy in cases of incipient ACS would also be of value in reducing medical costs.

Necrotizing Fasciitis: Review of the Literature and Case Report

“Necrotizing fasciitis” was the name rendered by Wilson 1 Wilson B. Necrotizing fasciitis. Ann Surg. 1952; 58: 144 Google Scholar in 1952. However, severe life-threatening necrotizing infections have been recognized throughout history, especially among military surgeons. 2 Ord R. Coletti D. Cervico-facial necrotizing fasciitis. Oral Dis. 2009; 15: 133 Crossref PubMed Scopus (37) Google Scholar Hippocrates, the Greek “father of medicine,” described necrotizing fasciitis (NF). 3 Adams F. The Genuine Works of Hippocrates. in: Syndenham Society, London1771: 400-401 Google Scholar NF was also described by Claude Ponteau, chief surgeon to the Hotel Dieu in Lyon, in 1783. 4 Blackadder H.H. Observations on Phagedena Gangraenosa. David Brown, Edinburgh1818 Google Scholar Past names given to the disease complex include malignant ulcer, gangrenous ulcer, putrid ulcer, phagedenis ulcer, phagedena gangraenosa, hospital gangrene, 5 McGurk M. Diagnosis and treatment of necrotizing fasciitis in the head and neck region. Oral Maxillofac Surg Clin North Am. 2003; 15: 59 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar gangrenous erysipelas, necrotizing cellulitis, Fournier gangrene, 6 Fournier J.A. Gangrene fourdroyant de la verge. Sem Med. 1883; 3: 345 Google Scholar and Meleney gangrene. 7 Meleney F. Hemolytic streptococcus gangrene. Arch Surg. 1924; 9: 317 Crossref Google Scholar NF was recorded at the Gendarmerie Hospital in Brussels after the Battle of Waterloo, 8 Henne J. Principles of Military Surgery. Constable, Edinburgh1820 Google Scholar and Florence Nightingale noted 80 cases in 1 month in Scutari. 9 Nightingale F. Notes on Hospitals. (ed 3). Longman, Green, London1863 Google Scholar In 1871 Jones, 10 Jones J. Investigation upon the nature, causes and treatment of hospital gangrene as prevailed in the Confederate armies 1861-1865. in: Surgical Memoirs of the War of the Rebellion. Hurd and Houghton, New York, NY1871: 142-580 Google Scholar a Confederate Army surgeon, referenced over 2,600 cases of “hospital gangrene” that bore a 46% fatality rate. Pfanner 11 Pfanner W. Fur Kenntis ud Behandlung des Nekrotisierenden Erysipelas. Deutsch Ztscher F Chir. 1918; 144: 108 Crossref Scopus (45) Google Scholar in 1918 described “necrotizing erysipelas” shown to be caused by a β-hemolytic streptococcus. Meleney 7 Meleney F. Hemolytic streptococcus gangrene. Arch Surg. 1924; 9: 317 Crossref Google Scholar in 1924 described 20 cases from Peking characterized by extensive and rapid subcutaneous necrosis due to β-hemolytic streptococci. Reports of “suppurative fasciitis” by McCafferty and Lyons 12 McCafferty E.L. Lyons C. Suppurative fasciitis as an essential feature of hemolytic streptococcus gangrene with notes on fasciotomy and early wound closure as treatment of choice. Surgery. 1948; 24: 438 PubMed Google Scholar in 1948 referred to a reduction in morbidity through early recognition and surgical intervention.

The effectiveness of different fasciotomy wound management treatment options following acute compartment syndrome: A systematic review protocol

The effectiveness of different fasciotomy wound management treatment options following acute compartment syndrome: A systematic review protocol

The effectiveness of different fasciotomy wound management treatment options following acute compartment syndrome: A systematic review protocol.

Review question/objective The overall objective of this review is to identify the best available evidence on the effectiveness of treatment options for managing fasciotomy wounds acquired due to treatment for acute compartment syndrome in the limbs. More specifically, the systematic review question is: What is the effectiveness of different treatment options for managing a fasciotomy wound on outcomes such as time to primary wound healing, percentage of patients who need skin grafts to effect closure of the wound and length of stay in hospital following the fasciotomies, in patients with acute compartment syndrome of the limb(s)? Inclusion criteria Types of participants The participants of interest are patients of any age who have acquired a fasciotomy wound as a result of treatment for acute compartment syndrome of the limb occurring as a result of injury (excluding compartment syndrome resulting from burns), regardless of co-morbidities or severity of injury. The co-morbidities, injury type and age will be taken into account when analysing the outcomes due to the impact of these factors on wound healing separate to the wound management options chosen. Types of interventions of interest This review will consider any human studies that evaluate the effectiveness of different treatment options for managing fasciotomy wounds. Types of treatment will include wound management aimed at both optimising the health of the open fasciotomy wound to prevent deterioration before the wound can be closed, and at achieving wound closure, including staged closure. Comparator The review will consider as a comparator the usual care of fasciotomy wound or other treatments of their fasciotomy wound. Types of outcomes This review will consider studies that include the following outcome measures: •Time to wound closure without skin grafting, measured in days between fasciotomy operation and definitive wound closure. •Time to wound closure where skin grafts have been used, measured in days between fasciotomy operation and wound closure. •Rate of wound healing without need for skin grafting. The numerator will be all fasciotomy wounds that require skin grafts to effect a definitive wound closure and the denominator will be all fasciotomy wounds included in the TRUNCATED AT 350 WORDS

Luggage tag tie technique for delayed primary closure of fasciotomy wounds

Split skin graft for managing fasciotomy wound is one of the commonest routine operating room procedures. However, it requires multiple surgical interventions ensuing into undesirable scaring both at donor and fasciotmy sites. Amongst the various delayed primary closures, we key out a controlled and segmental dermatotraction technique with easily available materials which reduces the cost of treatment, hospital stay and the surgical intervention as well. Our dynamic wound closure method facilitates resolution of edema, provides controlled traction at each point, takes care of tissue and prevents re-compartment syndrome. A simple modification, respecting the biochemical and physiological properties of skin, yields good results with luggage tag tie technique of delayed primary closure of fasciotomy wound.

Bilateral Gluteal Compartment Syndrome Following Robotic-Assisted Prostatectomy

Bilateral gluteal compartment syndrome is a rare condition. Only 6 previous cases have been reported in the literature. Two previous cases involved positioning for urological procedures, while the other cited causes of bilateral gluteal compartment syndrome include exercise-induced, trauma, and prolonged immobilization from substance abuse. The 2 previously published reports of bilateral gluteal compartment syndrome associated with urologic positioning were treated conservatively due to late presentation and onset of rhabdomyolysis. This article presents a case of a 61-year-old man who developed bilateral gluteal compartment syndrome following prolonged urologic surgery in a dorsal lithotomy position. Orthopedic evaluation revealed physical examination findings and intracompartment pressures consistent with bilateral gluteal compartment syndrome. He underwent bilateral gluteal compartment fasciotomies. An expansile-type Kocher Langenbach incision was made, extending from lateral to the posterior superior iliac spine inferior to the level of the greater trochanter. The 3 compartments were decompressed bilaterally. At completion, the compartments showed definite objective softening. He was treated with delayed closure of his fasciotomy wounds. He was discharged home on sixth postoperative day 6. His wounds healed without difficulty and he regained normal strength and sensation in his lower extremities. Gluteal compartment syndrome following surgery is a preventable condition. Prevention should center on intraoperative padding and positioning, intraoperative repositioning, and restricting the length of the procedure. Once it is identified, early diagnosis and treatment can prevent long term complications.

Fasciotomy wound closure-clinical audit and review of current practice

Fasciotomy wound closure-clinical audit and review of current practice

Ty-Raps in Trauma: A Novel Closing Technique of Extremity Fasciotomy Wounds

The challenge of closing extremity fasciotomy wounds is well known to every trauma and orthopedic surgeon. We developed a new, easy, and inexpensive dermatotraction technique based on the simple use of Ty-Raps and report on the first pilot study using this novel technique for the closure of 23 extremity fasciotomy wounds. The Ty-Rap system consists of several combinations of two Ty-Raps and four surgical staples. Immediately after fasciotomy, the system is secured to the skin by the surgical staples, and once the swelling of the affected limb is subsided, the Ty-Raps are tightened every 24 hours to 48 hours until full approximation of the skin edges is achieved. We recorded the time to closure of the wound, the time to removal of the Ty-Raps, and the complications related to the procedure. Also, a cost analyses was calculated. The mean time of approximation of the skin was 6.3 days, and after a further 9.4 days, the Ty-Raps could be removed. The majority of the wounds (91%) healed without complications, and only one patient in our series required a secondary surgical procedure for the closure of one fasciotomy wound. The total cost to close a fasciotomy wound of 30 cm with the use of Ty-Raps is US dollar 23.33. We regard the use of Ty-Raps a good alternative for the current closing techniques of extremity fasciotomy wounds. We value its low cost, general availability, effectiveness, and the fact that, in this pilot study, both the application and the tightening of the Ty-Raps were well tolerated by our patients with a minimal need for secondary procedures. Knowledge of this technique is a useful adjunct to the existing surgical array for every trauma and orthopedic surgeon for the closure of extremity fasciotomy wounds, especially in austere or military environments.

Influence of Prior Fasciotomy on Infection After Open Reduction and Internal Fixation of Tibial Plateau Fractures

High-energy tibial plateau fractures may present with an acute or impending compartment syndrome requiring emergent fasciotomy. There is little information regarding the optimal management of the fasciotomy wound with respect to the subsequent definitive internal fixation of the tibial plateau fracture. The purpose of this study was to compare the rate of infection complication after internal fixation of tibial plateau fractures in patients requiring fasciotomy for compartment syndrome with patients in whom a fasciotomy was not required. We retrospectively reviewed all tibial plateau fractures presenting over a 55-month period. Fourteen patients who presented with an associated compartment syndrome requiring fasciotomy and 128 patients in whom a fasciotomy was not performed met inclusion criteria. Patients age, sex, mechanism of injury, management of their fasciotomy, operative treatment of their plateau fracture, follow-up surgical procedures, follow-up complications, and length of follow-up were reviewed. Infection complications were defined as cellulitis requiring treatment with intravenous or oral antibiotics, patients requiring operative debridement after definitive fixation, and documentation of osteomyelitis. In the fasciotomy group, two patients developed cellulitis that was treated with a short course on oral antibiotics. There were no documented deep infections. In the no fasciotomy group, eight patients (6.25%) had a documented culture-positive deep infection. Additionally, six patients had documented occurrences of cellulitis managed with oral or intravenous antibiotics. Definitive internal fixation of tibial plateau fractures in the presence of open fasciotomy wounds does not seem to be associated with an increased infection risk.

Afrontamiento primario con elásticos vasculares en el manejo del cierre progresivo de fasciotomías

Vessel loops for primary closure of fasciotomies Background: Compartment syndrome of the extremity may occur after severe trauma with vascular lesions secondary to fractures, crushes or gunshots. To prevent it a fasciotomy must be done. Aim To report the use vessel loop shoelace technique for the progressive closure of the fasciotomy. Material and methods: Descriptive study of 24 patients aged 26 ± 9 years (21 males) that required fasciotomy to prevent compartment syndromes. The fasciotomy wound was closed progressively using vessel loops anchored to the skin with staples or sutures, which were tightened progressively, according to the evolution. Results: The studied pa- tients required a total of 56 fasciotomies. In all patients a complete or near complete closure of the wound was achieved. The mean closure time was 9.5 ± 3.3 days. Mean hospital stay was 12.3 ± 4.3 days. Conclusions: Vessel loop shoelace technique is effective for fasciotomy wound closure.

Acute Compartment Syndrome in Tibial Plateau Fractures—Beware!

Acute compartment syndrome can complicate fractures of the tibial plateau and must be recognized early so that timely fasciotomy can be performed. The presence of the open fasciotomy wound complicates management of the underlying proximal tibial fracture, which ideally needs early anatomic reconstruction of the articular surface and stable metaphyseal fixation. The purpose of this review is to highlight the importance of this problem, understand treatment strategies, and review outcomes.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.