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Original Article | Preliminary Reports After the 2023 Türkiye Earthquakes · Open access

Comparison of dermatotraction and negative pressure wound therapy for closure of cruris fasciotomy after 2023 Kahramanmaras earthquake

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Kasım Kılıçarslan

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0003-3852-4128

Yasin Erdoğan

Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye

ORCID: 0000-0001-6862-9671

Yavuz Karaman

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0002-6651-1212

Hilmi Alkan

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0002-5451-4678

Vedat Biçici

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0003-3923-1060

Abstract

Objectives: This study aims to evaluate the results of patients who underwent cruris fasciotomy for acute compartment syndrome (ACS) after the 2023 Kahramanmaras earthquake and used subcuticular polydioxanone (PDS) method or negative pressure wound therapy (NPWT) with vacuum-assisted closure (VAC) for fasciotomy follow-up and closure of the defect.

Patients and methods: Between March 2023 and April 2023, a total of 52 patients (31 males, 21 females; mean age: 29±14.8 years; range, 5 to 74 years) were retrospectively analyzed. The patients were divided into two groups as the dermatotraction (PDS) group (Group 1, n=30), and the VAC group (Group 2, n=22). Data including demographic, clinical, and operative data such as fasciotomy closure time, graft need, and infection rate were recorded.

Results: More grafts were needed to close the fasciotomy in patients followed with VAC. The mean closure time of the fasciotomy was 25.9±3.8 days in the PDS group and 27.3±3.5 days in the VAC group, indicating no significant difference between the groups (p=0.738). There was no significant difference in the rate of wound infection between the two groups (p=0.482).

Conclusion: Our study results suggest that more grafts are needed to close the fasciotomy in patients followed with VAC; however, it seems to increase the cost of the treatment.

Declarations

Ethics Committee Approval

The study protocol was approved by the Ankara City Hospital Ethics Committee (date: 08.03.2023, no: E1-23-3353). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept: K.K., Y.E., V.B.; Design, control/supervision: K.K., V.B.; Data collection and/or processing, writing the article: Y.E., Y.K.; Analysis and/or interpretation: K.K., Y.E.; Literature review: Y.E.; Critical review: V.B.; References and fundings, materials: Y.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Patient Consent for Publication

A written informed consent was obtained from each patient and/or parents or legal guardians of the patient.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. McQueen M. Acute compartment syndrome. Acta Chir Belg 1998;98:166-70.
  2. Schmidt AH. Acute compartment syndrome. Injury 2017;48 Suppl 1:S22-5. DOI: 10.1016/j.injury.2017.04.024.
  3. Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH. Acute compartment syndromes: Diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg [Am] 1978;60:1091-5.
  4. Chiverton N, Redden JF. A new technique for delayed primary closure of fasciotomy wounds. Injury 2000;31:21-4. DOI: 10.1016/s0020-1383(99)00193-x.
  5. Jauregui JJ, Yarmis SJ, Tsai J, Onuoha KO, Illical E, Paulino CB. Fasciotomy closure techniques. J Orthop Surg (Hong Kong) 2017;25:2309499016684724. DOI: 10.1177/2309499016684724.
  6. Atik OŞ. Which articles do the editors prefer to publish? Jt Dis Relat Surg 2022;33:1-2. DOI: 10.52312/jdrs.2022.57903.
  7. Hargens AR, Akeson WH. Pathophysiology of the compartment syndrome. In: Mubarak SJ, Hargens AR, editors. Compartment syndromes and Volkmann’s contracture. Saunders: Philadelphia; 1981. p. 47-70.
  8. Mabee JR. Compartment syndrome: A complication of acute extremity trauma. J Emerg Med 1994;12:651-6. DOI: 10.1016/0736-4679(94)90418-9.
  9. Velmahos GC, Theodorou D, Demetriades D, Chan L, Berne TV, Asensio J, et al. Complications and nonclosure rates of fasciotomy for trauma and related risk factors. World J Surg 1997;21:247-53. DOI: 10.1007/s002689900224.
  10. Hussmann J, Kucan JO, Zamboni WA. Elevated compartmental pressures after closure of a forearm burn wound with a skin-stretching device. Burns 1997;23:154-6. DOI: 10.1016/s0305-4179(96)00090-3.
  11. Taylor RC, Reitsma BJ, Sarazin S, Bell MG. Early results using a dynamic method for delayed primary closure of fasciotomy wounds. J Am Coll Surg 2003;197:872-8. DOI: 10.1016/S1072-7515(03)00646-X.
  12. Wiger P, Blomqvist G, Styf J. Wound closure by dermatotraction after fasciotomy for acute compartment syndrome. Scand J Plast Reconstr Surg Hand Surg 2000;34:315-20. DOI: 10.1080/028443100750059084.
  13. Janzing HM, Broos PL. Dermatotraction: An effective technique for the closure of fasciotomy wounds: A preliminary report of fifteen patients. J Orthop Trauma 2001;15:438-41. DOI: 10.1097/00005131-200108000-00010.
  14. Zannis J, Angobaldo J, Marks M, DeFranzo A, David L, Molnar J, et al. Comparison of fasciotomy wound closures using traditional dressing changes and the vacuumassisted closure device. Ann Plast Surg 2009;62:407-9. DOI: 10.1097/SAP.0b013e3181881b29.
  15. Kakagia D, Karadimas EJ, Drosos G, Ververidis A, Trypsiannis G, Verettas D. Wound closure of leg fasciotomy: Comparison of vacuum-assisted closure versus shoelace technique. A randomised study. Injury 2014;45:890-3. DOI: 10.1016/j.injury.2012.02.002.
  16. Révész ES, Altorjay Á, Montskó V, Hangody L. Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature. Jt Dis Relat Surg 2022;33:51-6. DOI: 10.52312/jdrs.2022.547.
  17. Krticka M, Ira D, Bilik A, Rotschein P, Svancara J. Fasciotomy closure using negative pressure wound therapy in lower leg compartment syndrome. Bratisl Lek Listy 2016;117:710-4. DOI: 10.4149/BLL_2016_136.
  18. Blonska-Staniec MK, Barczak AE, Garus A, Balchanowski N, Miszczuk JP. The use vacuum therapy in wound healing after fasciotomy in compartment syndrome - case report and literature review. Acta Angiologica 2016;22:158-63. DOI: 10.5603/AA.2016.0015.
  19. Morykwas MJ, Howell H, Bleyer AJ, Molnar JA, Argenta LC. The effect of externally applied subatmospheric pressure on serum myoglobin levels after a prolonged crush/ischemia injury. J Trauma 2002;53:537-40. DOI: 10.1097/00005373-200209000-00023.
  20. Gabriel A, Heinrich C, Shores J, Cho D, Baqai W, Moores D, et al. Outcomes of vacuum-assisted closure for the treatment of wounds in a paediatric population: Case series of 58 patients. J Plast Reconstr Aesthet Surg 2009;62:1428-36. DOI: 10.1016/j.bjps.2008.06.033.
  21. Weaver MJ, Owen TM, Morgan JH, Harris MB. Delayed primary closure of fasciotomy incisions in the lower leg: Do we need to change our strategy? J Orthop Trauma 2015;29:308-11. DOI: 10.1097/BOT.0000000000000278.
  22. Fowler JR, Kleiner MT, Das R, Gaughan JP, Rehman S. Assisted closure of fasciotomy wounds: A descriptive series and caution in patients with vascular injury. Bone Joint Res 2012;1:31-5. DOI: 10.1302/2046-3758.13.2000022.