The vessel loop shoelace technique for closure of fasciotomy wounds
The vessel loop shoelace technique for closure of fasciotomy wounds
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DOI：
10.1097/00000637-200044020-00017
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发表时间：
2000-02-01
影响因子：
1.5
通讯作者：
Spinelli, HM
中科院分区：
文献类型：
--
作者：
Asgari, MM;Spinelli, HM
四肢筋膜室综合征可发生在继发于骨折、血管缺血、挤压或电损伤的严重创伤后。为了避免对肌肉或神经造成永久性损伤，治疗方法包括适当的筋膜切开术。术后创面的处理传统上包括初次闭合、二次创面愈合或裂厚皮肤移植以覆盖缺损。筋膜切开术伤口可能继发于软组织肿胀和水肿。作者提出了一种筋膜切开术创面处理的替代方案，包括使用血管袢逐步闭合和渐进张力。术中在间隔释放期间放置血管环，并使用标准皮肤钉钉连接到伤口边缘。袢在术后常规换药时逐渐收紧，使伤口在2周内闭合。与裂厚移植相比，优点包括避免供体并发症和更好的美观。使用类似技术的零星病例报告已在骨科文献中发表，结果相似。目前的系列包括37例患者，年龄9至48岁，接受开放式筋膜切开术治疗。上肢创面11例，下肢创面26例，均在3周内愈合。
Compartment syndrome of the extremity may occur after severe trauma secondary to fractures, vascular ischemia, crush, or electrical injury. Treatment consists of expedient fasciotomy to avoid permanent injury to muscles or nerves. Management of the wounds postoperatively has consisted traditionally of primary closure, healing by secondary intention, or split-thickness skin grafting to cover defects. The fasciotomy wound may remain substantial secondary to soft-tissue swelling and edema. The authors present an alternative protocol for fasciotomy wound management, consisting of gradual closure with progressive tension using vessel loops. The vessel loops are placed intraoperatively during the compartment release and are attached to the wound margins using standard skin staples. The loops are tightened progressively postoperatively during routine dressing changes, resulting in closure of the wound within 2 weeks. The advantages over split-thickness grafting include avoidance of donor morbidity and better cosmesis. Sporadic case reports using similar techniques have been published in the orthopedic literature with comparable results. The current series includes 37 patients, ages 9 to 48 years, who were treated for open fasciotomy. There were 11 upper extremity and 26 lower extremity wounds treated, all of which were closed within 3 weeks.