scholarly journals Wound closure expectations after fasciotomy for paediatric compartment syndrome

2018 ◽  
Vol 12 (1) ◽  
pp. 9-14 ◽  
Author(s):  
E. D. Shirley ◽  
V. Mai ◽  
K. M. Neal ◽  
G. M. Kiebzak
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Upper Extremity ◽  
Skin Graft ◽  
Wound Closure ◽  
Acute Compartment Syndrome ◽  
Split Thickness Skin Graft ◽  
Paediatric Patients ◽  
Thickness Skin ◽  
Additional Surgery

Purpose Acute compartment syndrome often requires additional surgery to achieve wound closure. Little information exists regarding the expected number of surgeries, techniques and complications after closure in paediatric patients. Methods A retrospective chart review identified patients treated for acute compartment syndrome at four hospitals over a ten-year period. The cause of injury, type of dressing, number of surgeries, type of closure and complications were recorded. Results In all, 32 patients (mean 10.9 years, 1 to 17) who underwent 18 lower and 14 upper extremity fasciotomies met inclusion criteria. Definitive wound closure technique was delayed primary in 72%, split thickness skin graft in 25%, and primary in 3% of patients. Closure required a mean 2.4 surgeries (0 to 4) over a mean 7.7 days (0 to 34). Days to closure and number of surgeries required were not significantly affected by mechanism of injury, fasciotomy location or type of dressing used. A total of 23.1% of patients with upper extremity and 0% with lower extremity fasciotomies had concerns about the scar appearance. Other complications included neurapraxia (6.7%), stiffness (6.7%), swelling (3.3%), scar pain (3.3%) and weakness (3.3%). Conclusions The most common complication after paediatric compartment syndrome is an unpleasant scar. Wound closure after upper or lower extremity fasciotomies in paediatric patients requires a split thickness skin graft in approximately one in four patients. However, avoiding a skin graft does not guarantee the absence of cosmetic concerns, which are more likely following upper extremity fasciotomies. Level of Evidence IV

scholarly journals 2-Octyl Cyanoacrylate Glue Application on Split-Thickness Skin Graft for Lower Extremity Reconstruction

2021 ◽  
Vol 17 (3) ◽  
pp. 232-236
Author(s):  
Bu Hyeon Choi ◽  
Kyu Sang Cho ◽  
Jung Woo Chang ◽  
Jang Hyun Lee
Keyword(s):  
Lower Extremity ◽  
Skin Graft ◽  
Normal Skin ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Cyanoacrylate Glue ◽  
Time Saving ◽  
Thickness Skin ◽  
Lower Extremity Reconstruction

A split-thickness skin graft (STSG) is a very effective method for reconstructing skin defects in the lower extremities; however, suturing all graft margins during surgery is time-consuming. As an alternative, 2-octyl cyanoacrylate glue attaches the epidermal layer of an STSG to normal skin and functions like a suture. In this study, we assessed 2-octyl cyanoacrylate glue as a time-saving step in STSG procedures. We reviewed the charts of 87 patients who underwent STSG between May 2018 and August 2020. For the 10 patients who consented to the STSG procedure with 2-octyl cyanoacrylate glue, we evaluated the treatment site for complications and engraftment every 2 days for 14 days. The STSGs were successfully engrafted in all cases. Seroma, hematoma, wound dehiscence, or infection were not documented. No additional revision surgery was required. The use of 2-octyl cyanoacrylate glue in STSG margin fixation was safe, effective, convenient, and time-saving. This study found 2-octyl cyanoacrylate glue a good option for lower extremity skin defect reconstruction.

scholarly journals Esterified Hyaluronic Acid Matrix in Lower Extremity Reconstruction With Exposed Tendon and Bone: A Retrospective Review

2020 ◽  
Vol 41 (4) ◽  
pp. 828-834
Author(s):  
Steven D Kozusko ◽  
Mahmoud Hassouba ◽  
David M Hill ◽  
Xiangxia Liu ◽  
Kalyan Dadireddy ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Lower Extremity ◽  
Tissue Regeneration ◽  
Skin Graft ◽  
Endothelial Cell Migration ◽  
Split Thickness Skin Graft ◽  
Novel Technologies ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Exposed Bone

Abstract Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
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.

Contemporary Management and Outcome After Lower Extremity Fasciotomy in Non-Trauma-Related Vascular Surgery

2018 ◽  
Vol 52 (7) ◽  
pp. 493-497 ◽  
Author(s):  
Charlotte Wesslén ◽  
Carl-Magnus Wahlgren
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Compartment Syndrome ◽  
Multivariate Logistic Regression Analysis ◽  
Limb Ischemia ◽  
Aortic Disease ◽  
Acute Compartment Syndrome ◽  
Split Thickness Skin Graft ◽  
Acute Limb Ischemia ◽  
Endovascular Interventions

Introduction: Acute compartment syndrome (ACS) is a challenging and recognized complication to vascular surgery revascularization. The aim of this study was to investigate the current epidemiology, management, and early outcomes of fasciotomy in vascular surgery. Methods: Retrospective cohort study of all patients undergoing lower extremity fasciotomy at a single university center between January 2008 and December 2014. Patient demographics, operative techniques, and outcomes were analyzed. Results: The cohort (n = 113 limbs; 107 patients; 48% women; mean age was 74 (12) years [range, 50-97 years]) included 81 (72%) limbs undergoing revascularization for acute limb ischemia, 7 (6.2%) limbs related to acute aortic disease, and 23 (20%) limbs undergoing elective vascular surgery. Five patients underwent bilateral lower extremity fasciotomy. In all, 64 (57%) limbs had signs of ACS and underwent a therapeutic fasciotomy, while 49 (43%) fasciotomies were prophylactic. There were 20 (18%) fasciotomies performed after endovascular interventions. A 4-compartment fasciotomy was performed in 82% (n = 93) of limbs with a double incision technique. Split thickness skin graft was required in 11% (12/112) and vacuum-assisted closure treatment in 11% (12/111). The mean length of stay in hospital was 11 (9) days. Most common complication was lower extremity nerve deficit 32% (33/104) followed by wound infection 30% (32/108). At 30-day follow-up, amputation rate was 13% (14/107 limbs) and mortality 23% (25/107 patients). In the multivariate logistic regression analysis, prophylactic fasciotomy was associated with amputation (odds ratio: 28.9; 95% confidence interval: 1.96-425; P = .014). Conclusion: Acute compartment syndrome is primarily related to acute ischemic conditions but occurs after both aortic or elective vascular procedures and endovascular treatments. There are significant complications related to lower extremity fasciotomy in vascular surgery.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

scholarly journals Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang
Keyword(s):  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Salvage Procedure ◽  
Primary Defect ◽  
Scalp Defects ◽  
Thickness Skin ◽  
Scalp Defect ◽  
Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

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