%0 Journal Article
%T Shoelace Wound Closure for the Management of Fracture-Related Fasciotomy Wounds
%A Abdelsalam Eid
%A Mohamed Elsoufy
%J ISRN Orthopedics
%D 2012
%R 10.5402/2012/528382
%X 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每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. 1. Introduction Compartment syndrome is a serious complication that might occur following fractures. Untreated, it would cause serious damage to the nervous and muscular structures of the involved compartment(s), which might lead to serious and permanent functional deficit of the involved limb. The treatment of choice is emergent fasciotomy of all the involved muscle compartments to lower the compartment pressure [1每4]. Fasciotomy wounds can seldom be closed primarily because muscles under tension bulge through the wound making primary closure not feasible. The classic management of fasciotomy wounds was split thickness skin graft. This however led to an unsightly appearance as well as insensate area of skin over the graft [1每4]. Since no skin loss has occurred with the fasciotomy, and owing to the skin＊s ability to relax when under stress (creep), several authors [4每14] considered the use of skin stretching techniques to gradually or acutely close fasciotomy wounds. This process has been called by some authors dermatotration [6, 7]. To achieve this, some used specialized and costly equipment [4每8]. Our hypothesis was that 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. 2. Patients and Methods
%U http://www.hindawi.com/journals/isrn.orthopedics/2012/528382/