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Closure of Fasciotomy Wounds Using Rubber Bands for External Tissue Expansion
Kenny EM, Egro FM, Newmark J, Dvoracek LA, Lee JA, Russavage JM, Spiess AM, Acartürk TO
University of Pittsburgh Medical Center, Department of Plastic Surgery
2017-01-31
Presenter: Elizabeth Kenny
Affidavit:
Vu T. Nguyen
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Although decompressive fasciotomy is a limb-saving procedure in the setting of acute compartment syndrome, the resulting defect is difficult to close primarily. This study reports our experience with fasciotomy closure with external tissue expansion using rubber bands (RB).
Methods: Patients who opted for RB closure and had wounds that could not be approximated using the pinch test underwent the procedure. RBs were applied to the skin edges with staples and advanced at 3-4 mm intervals by twisting back and forth to create a criss-cross pattern. One week after application, wounds were closed primarily or underwent additional RB application, based on clinical assessment of skin advancement, compartment tension, and perfusion. Review of a prospectively maintained database was performed, including demographics, co-morbidities, etiology, wound and operative details, and complications.
Results: Thirteen consecutive patients (8 male, 5 female) with 21 fasciotomy wounds (10 ischemic, 7 traumatic, 4 vascular) on the upper (n=14, 66.7%) or lower (n=7, 33.3%) extremities underwent RB closure. Average wound length and width measured 15.9 cm (range 5-32 cm) and 5.4 cm (range 1-12 cm), respectively. Fifteen of 21 wounds (71.4%) were closed primarily after one RB application. Additional application was required for 5 wounds, and one patient requested split-thickness skin graft (STSG). Patients were discharged home between stages if no other conditions required in-hospital stay. No complications were observed and patient satisfaction was 100%.
Conclusion: The RB technique is an easy, safe, and cost-effective alternative for treating fasciotomy defects without the need for STSG or flap coverage.
