Kenny Elizabeth M, Egro Francesco M, Russavage James M, Spiess Alexander M, Acartürk Tahsin Oğuz
From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ann Plast Surg. 2018 Sep;81(3):344-352. doi: 10.1097/SAP.0000000000001506.
Although decompressive fasciotomy is a limb-saving procedure in the setting of acute compartment syndrome, it leaves a large wound defect with tissue edema and skin retraction that can preclude primary closure. Numerous techniques have been described to address the challenge of closing fasciotomy wounds. This study reports our experience with fasciotomy closure using rubber bands (RBs) for external tissue expansion.
Patients were informed about RB closure and split-thickness skin graft options. Only patients who opted for RB closure and had wounds that could not be approximated using the pinch test underwent the procedure. Starting from the apex and progressively advancing, the RBs were applied to the skin edges at 3 to 4 mm intervals using staples. The RBs were advanced by twisting back-and-forth to create a criss-cross pattern. One week after application, fasciotomy wounds were closed primarily or underwent further RB application, based on clinical assessment of adequacy of skin advancement, compartment tension, and perfusion. Review of a prospectively maintained database was performed, including demographics, comorbidities, etiology, wound and operative details, hospital stay, and complications.
Seventeen consecutive patients with 25 wounds (22 fasciotomy and 3 other surgical wounds) were treated using the RB technique. Average wound length and width measured 15.7 cm (range, 5-32 cm) and 5.2 cm (range, 1-12 cm), respectively. Locations of wounds included forearm (n = 12, 48.0%), leg (n = 7, 28.0%), hand (n = 4, 16.0%), elbow (n = 1, 4.0%), and hip (n = 1, 4.0%). Eighteen of 25 wounds (72.0%) were closed primarily after 1 RB application. Additional RB application was required for 5 wounds to achieve primary closure. Between stages, patients were discharged home if they did not have other conditions requiring in-hospital stay. No complications were observed, and no revision surgeries were required. Patient satisfaction was 100%, and all indicated that they would choose the RB technique over skin grafting.
The modified RB technique is a simple, safe, and cost-effective alternative for treating fasciotomy and other surgical defects resulting in high patient satisfaction and good cosmetic outcome, without the need for split-thickness skin graft or flap coverage.
尽管切开减压术是治疗急性骨筋膜室综合征时挽救肢体的一种手术，但术后会留下较大的伤口缺损，伴有组织水肿和皮肤回缩，可能无法进行一期缝合。已有多种技术被描述用于应对切开减压术后伤口闭合的挑战。本研究报告了我们使用橡皮筋（RB）进行外部组织扩张来闭合切开减压伤口的经验。
告知患者关于RB闭合和中厚皮片移植的选择。仅对选择RB闭合且伤口无法通过捏夹试验近似拉拢的患者进行该手术。从伤口顶端开始并逐步推进，使用吻合钉以3至4毫米的间隔将RB应用于皮肤边缘。通过来回扭转使RB推进，形成交叉图案。应用一周后，根据对皮肤推进程度、骨筋膜室张力和灌注情况的临床评估，对切开减压伤口进行一期闭合或进一步应用RB。对前瞻性维护的数据库进行回顾，包括人口统计学、合并症、病因、伤口和手术细节、住院时间及并发症。
连续17例患者的25个伤口（22个切开减压伤口和3个其他手术伤口）采用RB技术治疗。伤口平均长度和宽度分别为15.7厘米（范围5 - 32厘米）和5.2厘米（范围1 - 12厘米）。伤口部位包括前臂（n = 12，48.0%）、小腿（n = 7，28.0%）、手部（n = 4，16.0%）、肘部（n = 1，4.0%）和髋部（n = 1，4.0%）。25个伤口中有18个（72.0%）在应用1次RB后一期闭合。5个伤口需要额外应用RB以实现一期闭合。在各阶段之间，如果患者没有其他需要住院的情况，则可出院回家。未观察到并发症，也无需进行翻修手术。患者满意度为100%，所有患者均表示会选择RB技术而非皮片移植。
改良的RB技术是一种简单、安全且经济有效的治疗切开减压伤口及其他手术缺损的方法，患者满意度高，美容效果良好，无需中厚皮片移植或皮瓣覆盖。
