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Management of extremity fasciotomy sites prospective randomized evaluation of two techniques.

MedStar author(s):

Citation: American Journal of Surgery. 2018 Jul 26PMID: 30064725Institution: MedStar Washington Hospital CenterDepartment: Surgery/Burn ServicesForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2018 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0002-9610

Name of journal: American journal of surgeryAbstract: 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.Copyright (c) 2018 Elsevier Inc. All rights reserved.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 96h 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.SUMMARY: Primary closure of fasciotomy wounds is the optimal outcome for mechanical function and patient satisfaction. This prospective randomized controlled trial suggests primary closure can be achieved at rates better than previously reported in the literature, with a regimented approach to wound evaluation and a simple, cost-effective technique.All authors: Ball CG, Chaar M, Dente CJ, Feliciano DV, Johnson LS, Nicholas JM, Perez S, Rozycki GS, Wyrzykowski ADFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.amjsurg.2018.07.033

Date added to catalog: 2018-08-02

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30064725	Available		30064725

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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.

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 96h 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.

SUMMARY: Primary closure of fasciotomy wounds is the optimal outcome for mechanical function and patient satisfaction. This prospective randomized controlled trial suggests primary closure can be achieved at rates better than previously reported in the literature, with a regimented approach to wound evaluation and a simple, cost-effective technique.

English