Its therapeutic properties regarding fasciotomy wounds result from the positive effects of subatmospheric pressure. It involves the use of a foam dressing, covered by an adhesive drape that is connected to a vacuum pump in order to create subatmospheric pressure on the wound that is equally distributed, creating a controlled closed wound. Initially introduced in the late 1990s, NPWT has been widely used in the management of challenging wounds. Third, NPWT can be used as an adjunct to other closure techniques. Second, NPWT can be used as a definite treatment of fasciotomy wounds until wound healing is accomplished. First, it can be used as an alternative to the wet-dry dressings, which are traditionally used immediately after fasciotomy. Negative pressure wound therapy (NPWT) or vacuum-assisted wound closure can be applied in various ways in fasciotomy wound management depending on different wound conditions, progress of healing, and surgeon’s preference.
FASCIOTOMY OF LEG SKIN
Additionally, split-thickness skin grafting represents frequently a benchmark for evaluating complications, safety, efficacy, and cost-effectiveness of other newly introduced closure techniques. Yet, split-thickness skin grafting remains a viable option when other closure techniques fail or in special cases, as in persistently dehiscent wounds, in burnt or friable wound edges, and in very large skin defects. The use of skin grafts is associated with donor site morbidity, infection, lack of sensation over the fasciotomy site, risk of graft nonadherence, and poor cosmesis that, at times, requires scar revision or resection. Split-thickness skin grafting has been widely used for fasciotomy wound closure, as it has been thought to reduce patient morbidity from wound complications and delayed rehabilitation compared to immediately primarily or secondarily closed fasciotomy wounds. This chapter aims to summarize the available techniques employed in fasciotomy wound closure and to discuss the indications, advantages, disadvantages, and complications of these techniques in a way that readers may find useful and educative.Įarly primary wound closure of fasciotomy wounds, apart from being rarely possible due to edematous tissues, is also not recommended since it may lead to recurrent compartment syndrome. With no consensus existing in the literature regarding the best method for closure of fasciotomy wounds, the technique applied each time is based mostly on surgeon’s preference and other variables, such as the condition of the tissues surrounding the wound, availability of materials and devices, patients’ environment and preference, and institutional financial resources. As a result, closure of fasciotomy wounds is challenging, and a plethora of techniques have been proposed. However, early primary wound closure is not recommended as it may lead to increased muscle pressure and recurrent compartment syndrome. To reduce the risk of complications, the fasciotomy wound should be closed as quickly as possible. ( b) Fasciotomy was done, but because of muscle necrosis and sepsis, he ended with a knee disarticulation ( a) A 42-year-old man with a crush injury of the leg with tibia and fibula fracture. This chapter aims to summarize the available techniques employed in fasciotomy wound closure and to discuss the indications, advantages, disadvantages, and complications of these techniques in a way that readers may find useful and educative. With no consensus existing in the literature regarding the best method for closure of fasciotomy wounds, the technique applied each time is based mostly on surgeon’s preference, condition of the soft tissues, and availability of materials and devices. However, closure of fasciotomy wounds is challenging, and a plethora of techniques have been proposed. However, it is associated with complications, including long hospital stay, wound infection and osteomyelitis, need for further surgery for delayed wound closure or skin grafting, scarring, delayed bone healing, pain and nerve injury, permanent muscle weakness, chronic venous insufficiency, cosmetic problems, and an overall increased cost of care. Surgical fasciotomy is the only effective treatment for compartment syndrome.
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