Strategies in Trauma and Limb Reconstruction

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VOLUME 13 , ISSUE 1 ( April, 2018 ) > List of Articles

Original Article

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases

Naveen Mittal, Robin Bohat, Jagandeep Singh Virk, Payal Mittal

Keywords : Fasciotomy, Wound closure, Inexpensive, Dermotaxis, Loop suture technique

Citation Information : Mittal N, Bohat R, Virk JS, Mittal P. Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases. 2018; 13 (1):35-41.

DOI: 10.1007/s11751-017-0299-1

License: CC BY-NC-SA 4.0

Published Online: 30-04-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.

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  1. Mubarak SJ, Owen CA (1975) Compartmental syndrome and its relation to the crush syndrome, a spectrum of disease: a review of 11 cases of prolonged limb compression. Clin Orthop Relat Res 113:81
  2. McQueen MM, Christie J, Court-Brown CM (1996) Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg [Br] 78-B:95-98
  3. Fitzgerald M, Gaston P, Wilson Y, Quaba A, McQueen MM (2000) Long-term sequelae of fasciotomy wounds. Br J Plast Surg 53(8):690-693
  4. Barnea Y, Gur E, Amir A et al (2006) Delayed primary closure of fasciotomy wounds with Wisebands, a skin- and soft tissuestretch device. Injury 37(6):561-566
  5. Hirshowitz B, Lindenbaum E, Har-Shai Y (1993) A skinstretching device for the harnessing of the viscoelastic properties of skin. Plast Reconstr Surg 92(2):260-270
  6. Janzing HMJ, Broos PLO (2001) Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients. J Orthop Trauma 15(6):438-441
  7. Marek DJ, Copeland GE, Zlowodzki M, Cole PA (2005) The application of dermatotraction for primary skin closure. Am J Surg 190(1):123-126
  8. Gibson T (1977) The physical properties of skin. In: Converse JM (ed) Reconstructive plastic surgery, vol 1. Saunders, Philiadelphia, pp 70-77
  9. Branchet MC, Boisnic S, Frances C et al (1990) Skin thickness changes in normal aging skin. Gerontology 36:28-35
  10. Zannis J, Angobaldo J, Marks M et al (2009) Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device. Ann Plast Surg 62(4):407-409
  11. Boxer L, Buchman S (2002) An alternative method for closure of fasciotomy wounds: healing by secondary intention. Internet J Plast Surg 1(2):1-6
  12. Medina C, Spears J, Mitra A (2008) The use of an innovative device for wound closure after upper extremity fasciotomy. Hand 3(2):146-151
  13. Kakgaia D, Karadimas E, Drosos G, Ververidis A, Trypsiannis G, Verettas D (2014) Wound closure of leg fasciotomy: comparison of vacuum-assisted closure versus shoelace technique. A randomized study. Injury 45(5):890-893
  14. Yang CC, Chang DS, Webb LX (2006) Vacuum-assisted closure for fasciotomy wounds following compartment syndrome of the leg. J Surg Orthop Adv 15:19-23
  15. Saziye K, Mustafa C, Ilker U, Afksendyios K (2011) Comparison of vacuum-assisted closure device and conservative treatment for fasciotomy wound healing in ischaemia-reperfusion syndrome: preliminary results. Int Wound J 8:229-236
  16. Geertruida AM, Govaert G, van Helden S (2010) Ty-Raps in trauma: a novel closing technique of extremity fasciotomy wounds. J Trauma 69:972-975
  17. Fowler JR, Kleiner MT, Das R, Gaughan JP, Rehman S (2012) Assisted closure of fasciotomy wounds. A descriptive series and caution in patients with vascular injury. Bone Joint Res 1(3):31-35
  18. Harris I (1993) Gradual closure of fasciotomy wounds using a vessel loop shoelace. Injury 24(8):565-566
  19. McKenney M, Nir I, Fee T, Martin L, Lentz K (1996) A simple device for closure of fasciotomy wounds. Am J Surg 172:275-277
  20. Taylor RC, Reitsma BJ, Sarazin S, Bell MG (2003) Early results using a dynamic method for delayed primary closure of fasciotomy wounds. J Am Coll Surg 197(5):872-878
  21. Zorilla P, Marin A, Gomez LA, Salid JA (2005) Shoelace technique for gradual closure of fasciotomy wounds. J Trauma 59(6):1515-1517
  22. Ravinder S, Gill HS, Walia JPS, Brar BS, Nagra TS (2008) Management of skin loss by dermotaxis. J Bone Joint Surg Br 90-B(SUPP l):25
  23. Eid A, Elsoufy M (2012) Shoelace wound closure for the management of fracture related fasciotomy wounds. ISRN Orthop
  24. Chiverton N, Redden JF (2000) A new technique for delayed primary closure of fasciotomy wounds. Injury 31(1):21-24
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