Assisted closure of fasciotomy wounds
A descriptive series and caution in patients with vascular injury
Abstract
Introduction
Negative 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.
Methods
A 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.
Results
A 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.
Conclusion
This 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.
References
- 1
McQueen MMGaston PCourt-Brown CM . Acute compartment syndrome: who is at risk? J Bone Joint Surg [Br] 2000;82-B:200–203. Google Scholar - 2
McQueen MMChristie JCourt-Brown CM . Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg [Br] 1996;78-B:95–98. Abstract, Google Scholar - 3
Morykwas MJArgenta LCShelton-Brown EIMcGuirt W . Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38:553–562. Google Scholar - 4
Webb LX . New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg 2002;10:303–311. Google Scholar - 5
DeFranzo AJArgenta LCMarks MW , . The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 2001;108:1184–1191. Google Scholar - 6
Zannis JAngobaldo JMarks M , . Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device. Ann Plast Surg 2009;62:407–409. Crossref, Google Scholar - 7
Yang CCChang DSWebb LX . Vacuum-assisted closure for fasciotomy wounds following compartment syndrome of the leg. J Surg Orthop Adv 2006;15:19–23. Google Scholar - 8
Scherer LAShiver SChang MMeredith JWOwings JT . The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg 2002;137:930–934. Google Scholar - 9
Molnar JADeFranzo AJHadaegh A , . Acceleration of Integra incorporation in complex tissue defects with subatmospheric pressure. Plast Reconstr Surg 2004;113:1339–1346. Google Scholar - 10
Asgari MMSpinelli HM . The vessel loop shoelace technique for closure of fasciotomy wounds. Ann Plast Surg 2000;44:225–229. Google Scholar - 11
Berman SSSchilling JDMcIntyre KEHunter GCBernhard VM . Shoelace technique for delayed primary closure of fasciotomies. Am J Surg 1994;167:435–436. Google Scholar - 12
Harris I . Gradual closure of fasciotomy wounds using a vessel loop shoelace. Injury 1993;24:565–566. Google Scholar - 13
Janzing HMBroos PL . Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients. J Orthop Trauma 2001;15:438–441. Google Scholar - 14
Baum TPStrauch B . Delayed primary closure using Silastic vessel loops and skin staples: description of the technique and case reports. Ann Plast Surg 1999;42:337–340. Google Scholar - 15
Zorrilla PMarin AGomez LASalido JA . Shoelace technique for gradual closure of fasciotomy wounds. J Trauma 2005;59:1515–1517. Google Scholar - 16
Almekinders LC . Tips of the trade #32: gradual closure of fasciotomy wounds. Orthop Rev 1991;20:82–84. Google Scholar - 17
Marek DJCopeland GEZlowodzki MCole PA . The application of dermatotraction for primary skin closure. Am J Surg 2005;190:123–126. Google Scholar - 18
Schnirring-Judge MAAnderson EC . Vessel loop closure technique in open fractures and other complex wounds in the foot and ankle. J Foot Ankle Surg 2009;48:692–699. Google Scholar - 19
Barnea YGur EAmir A , . Delayed primary closure of fasciotomy wounds with Wisebands, a skin- and soft tissue-stretch device. Injury 2006;37:561–566. Google Scholar - 20
Medina CSpears JMitra A . The use of an innovative device for wound closure after upper extremity fasciotomy. Hand (N Y) 2008;3:146–151. Google Scholar - 21
Galois LPauchot JPfeffer F , . Modified shoelace technique for delayed primary closure of the thigh after acute compartment syndrome. Acta Orthop Belg 2002;68:63–67. Google Scholar - 22
McQueen MMCourt-Brown CM . Compartment monitoring in tibial fractures: the pressure threshold for decompression. J Bone Joint Surg [Br] 1996;78-B:99–104. Abstract, Google Scholar - 23
Williams PRRussell IDMintowt-Czyz WJ . Compartment pressure monitoring: current UK orthopaedic practice. Injury 1998;29:229–232. Google Scholar - 24
Harris IAKadir ADonald G . Continuous compartment pressure monitoring for tibia fractures: does it influence outcome? J Trauma 2006;60:1330–1335. Google Scholar
