DermaClose is quickly becoming the standard of care for fasciotomy closures

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.

Background

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.

Definition

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.

Diagnosis

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.

Absolute pressure greater than 30 mm Hg is indicative of impaired tissue perfusion in adults and children and, therefore, of the need for emergency surgical fasciotomy.
  • 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

Proposed Clinical Treatment Guidelines for Acute Extremity Compartment Syndrome.

Von Keudell AG, Weaver MJ, Appleton PT, et al.Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015;386:1299-1310.

Clinical publications

Clinical article

 Fasciotomy Wound Management and Closure

Article describes preferred method for closing fasciotomy wounds. To receive a printed reprint of this article click here and provide us with your mailing address.To review on the publisher’s website, click here.

Clinical Poster

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.

Case studies

18-1  18-2

31 year old male

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.

23-1  23-2

38 year old male patient

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.

Photos

 

Product literature

Reimbursement summary 2016
saving 2016

Reimbursement

For any questions regarding reimbursement, please contact our Director of Reimbursement services at 1-800-946-9012 ext. 5 or click here.

Fasciotomy-Brochure

DermaClose Fasciotomy Brochure: The Preferred Treatment for Closing Fasciotomy Wounds

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