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.

Closure of Fasciotomy Wounds

1997 ◽  
Vol 22 (2) ◽  
pp. 264-265 ◽  
Author(s):  
I. CALLANAN ◽  
A. MACEY
Keyword(s):  
General Anaesthesia ◽  
Medical Devices ◽  
Inpatient Care ◽  
Primary Closure ◽  
Skin Grafting ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

The closure of fasciotomy wounds creates problems for patient and surgeon alike. Split thickness skin grafting results in unsightly and insensate wounds and often requires general anaesthesia and prolonged inpatient care. We describe an improvement of a previously reported technique which is as effective as proprietary medical devices currently available. The technique may also be applied to the delayed primary closure of traumatic wounds.

Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections

2018 ◽  
Vol 84 (11) ◽  
pp. 1790-1795 ◽  
Author(s):  
Margaret H. Lauerman ◽  
Thomas M. Scalea ◽  
W. Andrew Eglseder ◽  
Raymond Pensy ◽  
Deborah M. Stein ◽  
...  
Keyword(s):  
Wound Closure ◽  
Skin Grafting ◽  
Wound Coverage ◽  
Secondary Intention ◽  
Primary Wound Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Necrotizing Soft Tissue Infections ◽  
Flap Creation

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.

scholarly journals Neonatal compartment syndrome

2016 ◽  
Vol 98 (7) ◽  
pp. e111-e113 ◽  
Author(s):  
B Martin ◽  
L Treharne
Keyword(s):  
Compartment Syndrome ◽  
Skin Grafting ◽  
Dermal Matrix ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Hand ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Contracture Release

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

A Proposed Algorithm for Managing the Open Abdomen

2005 ◽  
Vol 71 (3) ◽  
pp. 202-207 ◽  
Author(s):  
James Cipolla ◽  
Stanislaw P. Stawicki ◽  
William S. Hoff ◽  
Nathaniel Mcquay ◽  
Brian A. Hoey ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Skin Grafting ◽  
Fascial Closure ◽  
Saps Ii ◽  
Absorbable Mesh ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
The Mean ◽  
Surgical Conditions

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12–48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7%). Fascial closure was achieved in 6 patients (35.3%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates.

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.

scholarly journals 600 Bilateral Upper Limb Compartment Syndrome After Massive Postpartum Haemorrhage

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Payne ◽  
S Elahi
Keyword(s):  
Compartment Syndrome ◽  
Upper Limb ◽  
Unusual Case ◽  
Postpartum Haemorrhage ◽  
Skin Grafting ◽  
Trauma Patients ◽  
Capillary Refill ◽  
Left Hand ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Abstract Case Summary Upper limb compartment syndrome (ULCS) is an uncommon limb-threatening emergency occurring as a result of increased interstitial pressure within osteofascial compartments. The overwhelming majority of causes occur in one limb, with frequent causes including fractures, reperfusion injury and burns. We report the unusual case of bilateral upper limb CS in a previously well 35-year-old female secondary to massive resuscitation following postpartum haemorrhage. The patient received 7 litres of blood products and 4 litres of crystalloid over a period of 8 hours. One hour postoperatively both hands became painful and swollen. Symptoms worsened over the following hour: both forearms were tense to palpate with demonstrable pain on passive extension of bilateral wrists and digits of the left hand, and capillary refill to all digits was brisk. Creatinine kinase was measured at 4,600U/L and bilateral forearm and left-hand fasciotomies were performed. The presence of bulging muscles in both forearms and the left hand confirmed the diagnosis of compartment syndrome, and perfusion was restored to all digits after release of the compartments. The patient later underwent split thickness skin grafting to both forearms and left-hand fasciotomy wounds. After 5 weeks of hand therapy, she regained good function of both hands. Bilateral ULCS is extremely uncommon but has been reported secondary to massive resuscitation, particularly in trauma patients, and we suspect that this was the cause in our patient.

scholarly journals 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

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.

Outcomes of Split Thickness Skin Grafting on Lower Extremity Wounds in Diabetics

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 111-OR
Author(s):  
ELLIOT WALTERS ◽  
GREG STIMAC ◽  
NEHA RAJPAL ◽  
IRAM NAZ ◽  
TAMMER ELMARSAFI ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting
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