Management of extremity fasciotomy sites prospective randomized evaluation of two techniques

Laura S. Johnson*, Mitchell Chaar, Chad G. Ball, Sebastian Perez, Jeffrey M. Nicholas, Amy D. Wyrzykowski, Grace S. Rozycki, David V. Feliciano, Christopher J. Dente

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Introduction: Morbidity from the treatment of extremity compartment syndrome is underappreciated. Closure technique effectiveness has yet to be definitively established. Methods: A randomized non-blinded prospective study was performed involving patients who underwent an extremity fasciotomy following trauma. Shoelace wounds were strapped with vessel loops under tension and VAC wounds were treated with a standard KCI VAC dressing. After randomization, patients returned to the OR every 96 h until primarily closed or skin grafted. Results: 21 patients were consented for randomization with 11 (52%) successfully closed at the first re-operation. After interim analysis the study was closed early with 5/5 (100%) of wounds treated with the shoelace technique closed primarily and only 1/9 (11%) of VAC wounds closed primarily (p = 0.003). Overall primary closure was achieved in 74% of patients. Conclusions: Aggressive attempts at wound closure lead to an increased early closure rate. For wounds that remain open after the first re-operation, a simple shoelace technique is more successful than a wound VAC for achieving same hospital stay skin closure.

Original languageEnglish
Pages (from-to)736-739
Number of pages4
JournalAmerican Journal of Surgery
Volume216
Issue number4
DOIs
StatePublished - Oct 2018
Externally publishedYes

Keywords

  • Fasciotomy
  • Shoelace technique
  • Vacuum-assisted closure
  • Wound closure

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