Numerous case reports, a study at the Mayo Clinic, and a publication in the journal Orthopaedics documents the utility and effectiveness of DermaClose for fasciotomy closures.
Acute extremity compartment syndrome (AECS) is a surgical emergency requiring immediate attention. If medical attention is delayed the clinical sequela can be devastating. Unfortunately, acute extremity compartment syndrome is challenging to diagnose.
AECS is defined as an increase in intracompartmental pressure causing a decrease of perfusion pressure, leading to hypoxaemia of the tissues. Decreased tissue perfusion can lead to irreversible necrosis that might result in functional impairment, loss of limb, and, in rare cases, death.
- Acute extremity compartment syndrome is most frequently seen after a traumatic event, but in up to 30% of cases occurs without any evidence of fracture.
Treatment with fasciotomoy is the gold standard, but delays in surgical treatment can result in permanent injury.
Acute extremity compartment syndrome can be diagnosed on the basis of clinical symptoms, intra- compartmental pressure, or both.
The traditional 5 “P” mnemonic, (pallor, pain out of proportion, pulselessness, paraesthesia, and paralysis) is misleading.
Instead, if the patient is awake, the five Ps to consider are: pain, pain, pain, pain, and pain. Pain and paraesthesia are frequently seen in patients presenting with acute extremity compartment syndrome, but pallor, paralysis, and pulselessness might not be present at all or could be very late signs. However, there have been cases of acute compartment syndrome in patients without pain, therefore suspicion of the syndrome should be considered in high risk patients without excessive pain.
Measurement of intracompartmental tissue pressure might help to make a differential diagnosis. The physiological compartment pressures in adults are around 8 mm Hg and in children are 10–15mmHg.
- The lower leg is the most common location of acute extremity compartment syndrome, with the anterior and lateral compartments most frequently effected.
- Diaphyseal fractures of the tibia are mostly commonly associated with acute extremity compartment syndrome of the lower leg.
- Femur fractures resulting from road traffic accidents are the injuries most commonly associated with the development of acute extremity compartment syndrome in the thigh.
In all cases, fasciotomy can lead to severe scarring in some patients. Other long-term sequelae include paraesthesia, infection, and skin necrosis. Optimum timing of treatment is within 8 hours of symptoms. (view reference)
With DermaClose, you can typically achieve closure in 3 to 5 days and in addition:
- Reduce or eliminate the need for split thickness skin graft
- Reduce the risk of open wound complications
- Reduce operative visits and length of hospital stay
- Reduce scarring and improve cosmesis
- Use with NPWT if indicated
Mayo Clinic, Rochester, MN
A report of the effectiveness of continuous external tissue expansion as a method of fasciotomy wound closure. To view the poster, click here.
Presentation: Gunshot wound (GSW) to the left popliteal fossa. On exam patient had no palpable pulses in the left foot, with no sensation to touch and an inability to move the foot. X-ray revealed a comminuted distal femur fracture.
Size of wound: ~20 x 2cm
Time to closure: 5 days
Vac use: Yes
Outcome: The medial wound was closed primarily but there was too much tension to close the lateral fasciotomy site. On 10/8/08 a Dermaclose device was placed using the shoelace technique. The patient had no complaints of pain with the device in place.
Presentation: Deep Vein Thrombosis (DVT) which resulted in compartment syndrome, necessitating a fasciotomy of the lower right leg.
Size of wound: 35cm x 20cm
Time to closure: 9 days
Vac use: Yes
Outcome: The wound was dressed in the usual fashion and the patient returned to the OR three days later. The wound edges had fully approximated and the DermaClose devices were removed.