scholarly journals Bilateral post-traumatic forearm and hand compartment syndrome: a case report and review of literature

2016 ◽  
Vol 5 (1) ◽  
pp. 363
Author(s):  
Saubhik Das ◽  
Vivek Trikha ◽  
Sahil Gaba ◽  
Arkesh M. ◽  
Prabhat Agrawal ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Wound Management ◽  
Split Thickness Skin Graft ◽  
Interstitial Tissue ◽  
Loss Of Function ◽  
Tissue Pressure ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Post Traumatic

Acute compartment syndrome is a condition in which interstitial tissue pressure within a closed osteo-fascial compartment is elevated to a nonphysiologic level causing decrease in tissue perfusion, which if left elevated for sufficient time, can lead to tissue necrosis and devastating loss of function. It poses a diagnostic and therapeutic challenge for treating surgeons. We present a case of acute post-traumatic bilateral forearm and hand compartment syndrome in a 12 year old boy associated with fracture of distal ulna and metacarpals. Patient regained excellent function with emergent fasciotomy of volar forearm and hand followed by wound management with vacuum-assisted wound closure system (VAC), delayed primary closure and split-thickness skin graft (SSG). Early diagnosis and emergent fasciotomy are crucial to avoid debilitating complications.

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.

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

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.

scholarly journals Wound management using homemade vacuum dressing, affordable and customized (homemade vac)

2021 ◽  
Vol 6 (2) ◽  
pp. 41-45
Author(s):  
Kwesi Okumanin Nsaful ◽  
Stephane Gentil
Keyword(s):  
Skin Graft ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Third World ◽  
Wound Contraction ◽  
Wound Management ◽  
Split Thickness Skin Graft ◽  
Vacuum Assisted Closure ◽  
Thickness Skin ◽  
Dressing Materials

Introduction: The vacuum-assisted closure (VAC) has proved to be very promising in the management of difficult to heal wounds. However, the first reports about the use of negative pressure wound device came from Argenta and Morykwas in the year 1997. Though there are various commercially prepared and manufactured vacuum assisted closure dressing materials, these are often unavailable or unaffordable to patients in third world countries. Our “homemade” vacuum dressing has been found to be, affordable for our patients and most importantly effective in wound management. Materials and methods : The homemade Vacuum Assisted closure dressing was used for the management of some wounds which presented at our centre. These wounds were irrigated and thoroughly debrided. Our homemade vacuum assisted closure dressings were subsequently applied. Results: The wounds healed well with good granulation tissue. Subsequent split thickness skin graft (SSG) done had very good take. The VAC dressing often resulted in good wound contraction with no need for SSG. Conclusion: In our practice our “home made” vacuum which was affordable and customized proved to be effective in wound management.

The Ideal Donor Site Dressing: A Comparison of a Chitosan Based Gelling Dressing to Traditional Dressings

2021 ◽  
Author(s):  
Nkemjika Uke ◽  
Simran Singh ◽  
Grant E Sorensen ◽  
Joshua Frost ◽  
Amanda Venable ◽  
...  
Keyword(s):  
Skin Graft ◽  
Wound Care ◽  
Low Cost ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Application Rate ◽  
Care Plan ◽  
Wound Management ◽  
Split Thickness Skin Graft ◽  
Thickness Skin

Abstract Introduction Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7-14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. Methods We conducted a retrospective chart review of patients who received CBGD as part of their post-operative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. Results One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. Conclusions CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

scholarly journals Compartment Syndrome- Controversies and where are we Today

2017 ◽  
Vol 07 (02) ◽  
pp. 042-049
Author(s):  
M. Shantharam Shetty ◽  
Ajith Kumar ◽  
Lathika Shetty ◽  
Anbuchezhian Palanivel
Keyword(s):  
Early Diagnosis ◽  
Compartment Syndrome ◽  
Pressure Measurement ◽  
Interstitial Tissue ◽  
Compartment Pressure ◽  
Tissue Pressure

AbstractCompartment Syndrome in Orthopedic practice is a night mare and has to be diagnosed and treated as an emergency to save the function of the limb. Importance of different criteria of early diagnosis, compartment pressure measurement and immediate fasciotomy are the controversies even today. The review emphasizes the importance of these concerns. Definition Compartment syndrome occurs due to an increased interstitial tissue pressure inside a closed 1 space especially in an osseo-fascial compartment , should be treated as an acute emergency.

The Use of a 95° Blade Plate and a Posterior Approach to Achieve Tibiotalocalcaneal Arthrodesis

2002 ◽  
Vol 23 (8) ◽  
pp. 704-710 ◽  
Author(s):  
Travis W. Hanson ◽  
Andrea Cracchiolo
Keyword(s):  
Pain Relief ◽  
Internal Fixation ◽  
Posterior Approach ◽  
Split Thickness Skin Graft ◽  
Blade Plate ◽  
Thickness Skin ◽  
Solid Fusion ◽  
Post Traumatic ◽  
Hindfoot Deformity

Various types of internal fixation have been used to achieve arthrodesis of both the ankle and subtalar joints. We have investigated the use of a standard 95° angled blade plate as a method of more rigid internal fixation to achieve arthrodesis of these joints. The purpose of this retrospective study was to review our clinical and radiographic results in adults using a blade plate applied through a posterior approach to fuse the ankle and subtalar joints. Methods: Between April 1995 and June 2000, 10 tibiotalocalcaneal arthrodeses were performed using a posterior approach and a blade plate for internal fixation. There were 10 adults (five men and five women) whose average age was 64 years (range, 42 to 80 years). The indication for the procedure was severe pain which was unresponsive to nonoperative management in patients with arthritic joints. Preoperative diagnoses included six patients with post-traumatic arthritis, two with primary degenerative arthritis, one with rheumatoid arthritis, and one with post-polio deformity. An average of 1.7 previous operations had been performed on the affected ankle. Results: Clinical and radiographic follow-up was performed for all patients at an average of 37 months (range, 12 to 71 months) postoperatively. All 10 patients achieved a solid fusion. The mean time to radiographic fusion was 14.5 weeks (range, 9 to 26 weeks). The operation resulted in plantigrade feet in all patients with an average tibia-floor angle of 2.3° of dorsiflexion and an average of 5° of hindfoot valgus. Patients had excellent pain relief, however function did not improve as much. Complications occurred in three patients. One patient required a small split-thickness skin graft for wound healing, one experienced a transient posterior tibial nerve neuropraxia, and one developed a deep venous thrombosis in the nonoperative leg at six weeks postoperatively. Three patients required removal of the blade plate because of discomfort, which promptly cleared. Conclusions: Arthrodesis provides excellent pain relief for patients with painful arthritic deformities of the ankle and subtalar joints. Using a posterior approach, a blade plate for internal fixation and bone grafts resulted in a solid fusion for all our patients. This method is particularly effective in large patients with a mild-moderate hindfoot deformity.

scholarly journals Management of Patient with Closed Degloving in the Pelvic Region: a Case Series

1970 ◽  
Vol 1 (5) ◽  
Author(s):  
Tessa Miranda Atmadja ◽  
Gentur Sudjatmiko
Keyword(s):  
Case Series ◽  
Wound Management ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Pelvic Region ◽  
Thickness Skin ◽  
Systemic Problems ◽  
Closed Degloving ◽  
Degloving Injuries ◽  
Wound Bed Preparation

Background: Degloving injuries in pelvis, torso and extremities present a challenge in wound management. Current management usually is the effort to provide wound coverage with split thickness skin graft (STSG). Problems arise in the wound bed preparation because the patient is not mobile, urine or feces contamination, and systemic problems such as anemia, hypoalbuminemia and sepsis. After wound coverage with STSG, problems arise during postoperative period caused by dificulty to maintain immobilization of the graft due to the location.Patients and Methods: In January to February 2012, 3 patients were admitted to Cipto Mangunkusumo hospital with degloving in the pelvic region. They were treated with delayed STSG.Results : The first patient underwent delayed STSG with a 75% take. The second patient was treated by serial STSG a month following hospital admission, the result was almost 90% take. The last patient underwent debridement and the wound was closed with STSG 10 days after admission, the result was only 50% take.Summary : Management of degloving patients should include adequate wound bed preparation with dressing that minimize infection and enhance good granulation tissue, maintain good systemic condition by providing adequate nutrition with care to albumin and electrolyte loss. Care should be given to prevent SIRS and sepsis. After wound coverage with STSG, modalities to immobilize the graft and maintain ideal environment for graft take have to be considered.

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

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