Govaert Geertruida A M, van Helden Svenhjalmar
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
J Trauma. 2010 Oct;69(4):972-5. doi: 10.1097/TA.0b013e3181f2d9d3.
The challenge of closing extremity fasciotomy wounds is well known to every trauma and orthopedic surgeon. We developed a new, easy, and inexpensive dermatotraction technique based on the simple use of Ty-Raps and report on the first pilot study using this novel technique for the closure of 23 extremity fasciotomy wounds. The Ty-Rap system consists of several combinations of two Ty-Raps and four surgical staples. Immediately after fasciotomy, the system is secured to the skin by the surgical staples, and once the swelling of the affected limb is subsided, the Ty-Raps are tightened every 24 hours to 48 hours until full approximation of the skin edges is achieved. We recorded the time to closure of the wound, the time to removal of the Ty-Raps, and the complications related to the procedure. Also, a cost analyses was calculated. The mean time of approximation of the skin was 6.3 days, and after a further 9.4 days, the Ty-Raps could be removed. The majority of the wounds (91%) healed without complications, and only one patient in our series required a secondary surgical procedure for the closure of one fasciotomy wound. The total cost to close a fasciotomy wound of 30 cm with the use of Ty-Raps is US dollar 23.33. We regard the use of Ty-Raps a good alternative for the current closing techniques of extremity fasciotomy wounds. We value its low cost, general availability, effectiveness, and the fact that, in this pilot study, both the application and the tightening of the Ty-Raps were well tolerated by our patients with a minimal need for secondary procedures. Knowledge of this technique is a useful adjunct to the existing surgical array for every trauma and orthopedic surgeon for the closure of extremity fasciotomy wounds, especially in austere or military environments.
每位创伤和骨科外科医生都深知闭合四肢筋膜切开伤口的挑战。我们基于简单使用尼龙扎带开发了一种新的、简便且经济的皮肤牵引技术，并报告了首例使用这种新技术闭合23例四肢筋膜切开伤口的初步研究。尼龙扎带系统由两个尼龙扎带和四个手术吻合钉的几种组合构成。筋膜切开术后立即用手术吻合钉将该系统固定在皮肤上，一旦患肢肿胀消退，每隔24至48小时收紧尼龙扎带，直至皮肤边缘完全对合。我们记录了伤口闭合时间、尼龙扎带拆除时间以及与该操作相关的并发症。此外，还进行了成本分析。皮肤对合的平均时间为6.3天，再过9.4天后可拆除尼龙扎带。大多数伤口（91%）愈合无并发症，我们系列中只有一名患者需要进行二次手术来闭合一处筋膜切开伤口。使用尼龙扎带闭合30厘米的筋膜切开伤口的总成本为23.33美元。我们认为使用尼龙扎带是当前四肢筋膜切开伤口闭合技术的一个很好的替代方法。我们重视其低成本、普遍可得性、有效性，以及在这项初步研究中，患者对尼龙扎带的应用和收紧耐受性良好，二次手术需求极少这一事实。对于每位创伤和骨科外科医生而言，了解这项技术是现有手术方法的一项有用补充，有助于闭合四肢筋膜切开伤口，尤其是在艰苦或军事环境中。
