Dynamic Wound Closure for Decompressive Leg Fasciotomy Wounds

Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential technique in trauma. The wounds that result from the standard two incision four-compartment leg fasciotomy are often accompanied by a wide soft tissue opening that in the face of true compartment syndrome are often impossible to close in a delayed primary fashion. We describe a technique using a device that allows for dissipation of the workload across the wound margin allowing for successful delayed primary closure. Consecutive patients who presented to the 28th Combat Support Hospital in Baghdad, Iraq with a diagnosis of compartment syndrome of the leg, impending compartment syndrome of the leg, or compartment syndrome of the leg recently treated with fasciotomies were followed. All patients underwent placement of the Canica dynamic wound closure device (Canica, Almonte, ON, Canada). Eleven consecutive patients treated at a combat support hospital in support of Operation Iraqi Freedom underwent four-compartment fasciotomies for penetrating injuries. There were five patients that underwent a vascular repair [three superficial femoral artery (SFA) injuries and two below knee popliteal artery injuries] and six patients that had orthopedic injuries (three comminuted tibial fractures, two fibula fractures, and one closed pilon fracture). Patients returned to the operating room within 24 hours for washout and wound inspection. Mean initial wound size was 8.1 cm; mean postplacement size was 2.7 cm; average time to closure was 2.6 days. All patients were able to undergo primary wound closure of the medial incision and placement of the Canica device over the lateral incision. Ten of the 11 patients (91%) could be closed in delayed primary fashion after application of the device. In our series of patients with penetrating wartime injuries and compartment syndrome of the leg we have found the use of this dynamic wound closure device to be extremely successful and expedient.

Download Full-text

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

Malaysian Journal of Science Health & Technology ◽

10.33102/mjosht.v7i2.189 ◽

2021 ◽

Vol 7 (2) ◽

pp. 76-78

Author(s):

Mohd Asha'ari Bain ◽

Mohd Shaffid Md Shariff ◽

Mohamad Hilmi Mohamad Nazarallah ◽

Nur Dina Azman ◽

Abu 'Ubaidah Amir Norazmi

Keyword(s):

Compartment Syndrome ◽

Primary Closure ◽

Open Fracture ◽

Wound Closure ◽

Skin Grafting ◽

Delayed Primary Closure ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Forearm Compartment Syndrome ◽

Good Cosmesis

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.

Download Full-text

ACUTE BILATERAL FOREARM COMPARTMENT SYNDROME OF UNKNOWN AETIOLOGY

Hand Surgery ◽

10.1142/s0218810406003243 ◽

2006 ◽

Vol 11 (03) ◽

pp. 147-149 ◽

Cited By ~ 4

Author(s):

E. J. P. O'Leary ◽

N. W. Bulstrode ◽

C. Gschwind

Keyword(s):

Clinical Outcome ◽

Compartment Syndrome ◽

Wound Closure ◽

Histopathological Examination ◽

Exercise Programme ◽

Surgical Decompression ◽

Unknown Aetiology ◽

Primary Wound Closure ◽

Motion Exercise ◽

Forearm Compartment Syndrome

This is the first reported case of non-traumatic, acute bilateral forearm compartment syndrome. Despite a delay of over 24 hours until surgical decompression and 50% muscle fibre necrosis in the histopathological examination, the clinical outcome was excellent after fasciotomy, delayed primary wound closure and early institution of a range of motion exercise programme. The literature on non-traumatic causes of compartment syndrome is reviewed.

Download Full-text

Evaluation of partial wound closure in perforated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20193316 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2726

Author(s):

Muhammed H. Jaafar Al-Sa'adi ◽

Ali Laibi Zamil

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Primary Closure ◽

Wound Closure ◽

Perforated Appendicitis ◽

Pathological State ◽

Open Wound ◽

Primary Wound Closure ◽

Delayed Primary Closure ◽

Hospital Stays

Background: Perforated appendicitis is a serious complication of acute appendicitis that usually occurs due to over delay in presentation, diagnosis, and surgical treatment. Wound infection is one of the important sequelae of perforated appendicitis. Method of the wound closure in perforated appendicitis is a critical factor that affects the incidence of wound infection and there is continuing controversy about the best method.Methods: 362 patients with a diagnosis of acute appendicitis were enrolled in a prospective randomized study that extended over three years. The intraoperative gross pathological state of the appendix was recorded as either negative or uncomplicated or perforated appendicitis. The relationship between the wound infection with each one of the three methods of wound closure (primary closure, open wound with delayed primary closure and partial wound closure) had been reported. The hospital stays were recorded for each method.Results: 18.78% of appendectomy was appendicitis negative, 62.98% uncomplicated appendicitis and 18.23% with perforated appendicitis. In the perforated appendicitis cases, Primary wound closure was used in 36.36%, open method and delay primary closure in 18.18% and partial wound closure in 45.45%. The wound infection rates were 37.5%, 16.66% and 13.33% in primary wound closure, open wound with delayed primary closure and partial wound closure respectively. Length of hospital stays were 7 days, 8 days and 4 days respectively.Conclusions: partial wound closure is superior to other methods of wound closure, which are primary wound closure and open wound with delayed primary wound closure.

Download Full-text

Shoelace Wound Closure for the Management of Fracture-Related Fasciotomy Wounds

ISRN Orthopedics ◽

10.5402/2012/528382 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Abdelsalam Eid ◽

Mohamed Elsoufy

Keyword(s):

Compartment Syndrome ◽

Wound Closure ◽

Femoral Fractures ◽

University Hospital ◽

Split Thickness Skin Graft ◽

Skin Closure ◽

Compartment Pressure ◽

Delayed Primary Closure ◽

Thickness Skin ◽

Secondary Healing

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.

Download Full-text

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

International Surgery Journal ◽

10.18203/2349-2902.isj20200300 ◽

2020 ◽

Vol 7 (2) ◽

pp. 471

Author(s):

Hareesh H. D. ◽

Thrishuli P. B. ◽

Girish Kumar N. M.

Keyword(s):

Hospital Stay ◽

Compartment Syndrome ◽

Primary Closure ◽

Wound Closure ◽

Wound Complications ◽

Delayed Primary Closure ◽

Wide Range ◽

Significant Difference ◽

Group A ◽

Group B

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.

Download Full-text

Reconstruction of face and scalp after dog bites in children

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016006007 ◽

2016 ◽

Vol 43 (6) ◽

pp. 452-457 ◽

Cited By ~ 7

Author(s):

JEFFERSON LESSA SOARES MACEDO ◽

SIMONE CORRÊA ROSA ◽

MURILO NEVES DE QUEIROZ ◽

TABATHA GONÇALVES ANDRADE CASTELO BRANCO GOMES

Keyword(s):

Surgical Treatment ◽

Wound Closure ◽

Primary Treatment ◽

Infectious Complications ◽

Regional Hospital ◽

Patient Admission ◽

Emergency Unit ◽

Immediate Reconstruction ◽

Primary Wound Closure ◽

The Face

ABSTRACT Objective: to evaluate the immediate reconstruction of face and scalp after canine bites in children. Methods: we conducted a prospective series of cases treated at the Emergency Unit of the Asa Norte Regional Hospital, Brasília - DF, from January 1999 to December 2014. At the time of patient admission to the emergency, the primary wound closure of the face and scalp bite was performed, regardless of the time or day of the event. The primary treatment of the bites was by means of direct suture, flaps rotation or grafting, depending on the type of wound and surgeon's decision. Results: the study comprised 146 children, with the zygomatic region and scalp being the main sites of head bites. All patients received surgical treatment within the first 24 hours after admission. There were no infectious complications in the cases studied. Conclusion: the findings suggest that the immediate closure of canine bites on the face and scalp in children is safe, even when carried out several hours after injury.

Download Full-text