Fasciotomy closure

Prévia do material em texto

See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/313488461
Fasciotomy	closure	techniques:	A	meta-
analysis
Article	·	January	2017
DOI:	10.1177/2309499016684724
CITATIONS
0
READS
73
6	authors,	including:
Julio	J.	Jauregui
University	of	Maryland	Medical	Center
120	PUBLICATIONS			341	CITATIONS			
SEE	PROFILE
Emmanuel	Michael	Illical
State	University	of	New	York	Downstate	Medi…
11	PUBLICATIONS			13	CITATIONS			
SEE	PROFILE
All	content	following	this	page	was	uploaded	by	Emmanuel	Michael	Illical	on	20	October	2017.
The	user	has	requested	enhancement	of	the	downloaded	file.
Review
Fasciotomy closure techniques:
A meta-analysis
Julio J Jauregui1, Samantha J Yarmis2, Justin Tsai2,
Kemjika O Onuoha2, Emmanuel Illical2, and Carl B Paulino2
Abstract
We evaluated the risks and success rates of the three major techniques for compartment syndrome fasciotomy closure by
reviewing all literature published to date. Following the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses guidelines, we systematically evaluated the Medline (PubMed) database until July 2015, utilizing the Boolean
search sting ‘‘compartment syndrome OR fasciotomy closure.’’ Two authors independently assessed all studies published
in the literature to ensure validity of extracted data. The data was compiled into an electronic spreadsheet, and the wound
closure rate with each technique was assessed utilizing a proportion random model effect. Success was defined as all
wounds that could be closed without skin grafting, amputation, or death. The highest success rate was observed for
dynamic dermatotraction and gradual suture approximation, whereas vacuum-assisted closure had the lowest compli-
cation rate.
Keywords
fasciotomy, closure, compartment syndrome, complications, wound closure
Introduction
Fasciotomy is the standard treatment for acute compart-
ment syndrome (ACS).1 Historically, fasciotomy incisions
were either left open or immediately closed; however, the
rates of infections and recurrent compartment syndrome
were unacceptably high.2 In an attempt to improve out-
comes, there is a plethora of different wound closure tech-
niques published, which includes immediate closure,
delayed primary closure, and ultimately utilizing a skin
graft to fill the void.1,3 Immediate or delayed primary
wound closure may help decrease the infection rates and
improve the cosmetic outcomes when compared with sec-
ondary closure and skin grafts.3 However, primary closure
is not always possible, due to tissue edema.4
Currently, there is no consensus regarding which tech-
nique should be used when closing fasciotomy incisions.1
As a result, wound closure technique is based on the sur-
geon’s preference and the requirements of each clinical
scenario.5 Different techniques have diverse success rates,
times to closure, and complication rates.1,6,7 If an initial
attempt of closure is unsuccessful, subsequent reoperation
with another closure technique and/or grafting may be
required. However, grafting itself is associated with signif-
icant morbidity, poor cosmetic results, and pain at the graft
donation site.8 Furthermore, regardless of which closure
technique is used, it is always important to understand the
complications associated with the underlying cause of com-
partment syndrome or the fasciotomy itself, such as infec-
tion, delayed bone healing, amputation, or even death.7,8
Although multiple wound closure techniques are
described in the orthopedic literature, there is limited data
regarding the efficacy and safety of these techniques fol-
lowing a fasciotomy. In addition, due to the heterogeneity
in the type and quality of studies, the relatively high
1Department of Orthopaedics, University of Maryland Medical Center,
Baltimore, MD, USA
2Department of Orthopaedic Surgery and Rehabilitation, SUNY
Downstate Medical Center, Brooklyn, New York, NY, USA
Corresponding author:
Carl B Paulino, Department of Orthopaedic Surgery and Rehabilitation,
SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30,
Brooklyn, NY 11203, USA.
Email: Paulinomd@gmail.com
Journal of Orthopaedic Surgery
25(1) 1–8
ª Journal of Orthopaedic Surgery 2017
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/2309499016684724
journals.sagepub.com/home/osj
Journal ofOr thopaedic
Surger y
complication rates, and the clinical burden, there is a need
for a systematic review of the literature to assess the current
evidence regarding fasciotomy closure techniques. The
goals of this study are to (1) determine the current tech-
niques available for fasciotomy wound closure; (2) assess
the overall success of these techniques in achieving wound
closure in the extremities; and (3) evaluate the effective-
ness of these techniques in minimizing the time required for
fasciotomy wound closure and complication rates.
Methods
We performed a systematic search of the literature using
the Medline (PubMed) library to identify all studies that
have evaluated fasciotomy wound closure. This was per-
formed following utilizing the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines.9 Two authors independently assessed all studies
published in the literature until July 2015 using the follow-
ing search strings: ‘‘compartment syndrome OR fasciot-
omy closure,’’ which returned a total of 8577 abstracts.
These studies were carefully evaluated to determine those
that were relevant. The following inclusion criteria were uti-
lized: (1) full-text reports; (2) randomized controlled trials
(RCTs), cohort studies, case–control studies, and case series
with two or more patients; (3) studies involving patients with
ACS of the extremities treated with fasciotomy; (4) studies
describing the method of fasciotomy closure; and (5) studies
that reported time to closure as an outcome measure. Studies
published in languages other thanEnglish, single case reports,
articles regarding exercise-induced compartment syndrome,
and articles whose outcome measures did not include time to
closure for each closure technique were excluded.
A total of 90 potential studies were determined to be
potentially relevant. These were cross-referenced to identify
an additional 17 potential studies. These 107 studies were
carefully evaluated and 52 met inclusion criteria. Of these
52 studies, 29 were excluded due to the following reasons:
3 studies did not stratify the time to wound closure according
to the technique used10–12; 2 studies did not separate wound
closure following fasciotomy from wound closure following
other procedures13,14; 2 studies explored only static tension
techniques (Steri-Strips)3,15; and 22 studies examined only
split thickness skin graft (STSG) and/or conservative treat-
ment.2,4,8,16–34 Figure 1 displays a summary of the research
methodology. The 23 remaining studies were included in the
final analysis and are described in Tables 1–6.
The data for the studies were compiled into an electronic
spreadsheet (Microsoft Excel, Microsoft Office, Redmond,
Washington, USA). Statistical analysis was performed
using a statistical software (Med Calc, MedCalc Software
bvba, Ostend, Belgium). We performed forest plots of the
proportion of wounds that were successfully closed with
each technique. Success was defined as all wounds that
could be closed without skin grafting, amputation, or death.
This study was performed with no external funding.
Description of each technique
Conservative
Conservative treatment generally consists of wet-to-dry
dressings, followed by delayed primary closure (DPC).Healing by secondary intention is employed if DPC is not
possible.3,35
Split-thickness skin graft
Historically, STSG was the only alternative if conservative
treatment failed or was deemed impossible due to the size
of the fasciotomy wound.2,12 However, STSG is associated
with significant morbidity, including risks associated with
an additional surgery under general anesthesia, pain at the
graft donor site, infection, lack of sensation in the grafted
area, risk of graft nonadherence, and poor cosmetic out-
comes.1 Despite the significant risks associated with STSG,
it is still frequently used when alternative methods fail.
Gradual suture approximation
Several variations of the ‘‘shoelace’’ technique have been
used to gradually approximate the wound edges.36 The
technique, as initially proposed by Cohn et al., involves the
placement of staples along the wound edges, followed by
8577 studies identified using search strings
90 potential studies identified after abstract 
review and read in detail
17 additional studies identified through 
cross-referencing
52 studies met inclusion criteria
(2) – Examined Steri-Strips® alone
(22) – Examined STSG and/or conservative 
treatment alone
Excluded studies:
23 studies included in final analysis
107 potential studies identified
(2) – Not stratified by wound type
(3) – Closure time not stratified by 
technique
Figure 1. Search methodology flowchart.
2 Journal of Orthopaedic Surgery 25(1)
Table 1. Studies evaluating gradual suture approximation, demographics, and success rate.
Authors, year
Level of
evidence
N of
patients
Male
(%)
Age mean
(range)
N of upper limb
fasciotomies
N of lower limb
fasciotomies Closure method
Success
rate (%)
Asgari et al.,
2000
IV 37 68 28 (9–48) 11 26 Shoelace (vessel loop) 100
Chiverton et al.,
2000
IV 6 100 NR (NR) 0 6 Subcuticular prolene suture 100
Cohn et al., 1986 IV 2 100 39.5 (18–61) 2 0 Shoelace (vessel loop) 100
Eid et al., 2012 IV 17 76 23.3 (16–35) 0 17 Shoelace (catheter) 71
Govaert et al.,
2010
IV 13 92 35.3 (13–64) 6 17 Ty-Raps 91
Harris et al.,
1993
IV 5 NR NR (NR) 0 5 Shoelace (vessel loop) 100
Janzing et al.,
2001a
III 5 NR NR (NR) NR NR Shoelace (vessel loop) 100
Janzing et al.,
2001b
III 5 NR NR (NR) NR NR Prepositioned
intracutaneous suture
100
Kakagia et al.,
2012
II 25 NR 35.1 (21–52) 0 40 Shoelace (vessel loop) 100
Ozyurtlu et al.,
2014
IV 5 80 35.8 (30–39) 3 2 V-Loc (subcuticular) 100
Walker et al.,
2012
IV 69 64 65.3 (20–95) NR NR Silicon sheet 53
Zorilla et al.,
2005
IV 20 90 38 (2–88) 7 13 Shoelace (vessel loop) 100
N: number; NR: not reported.
aand breported twice due to different variations in closure technique, conventional (a) versus intracutaneous (b).
Table 2. Studies evaluating dynamic dermatotraction, demographics, and success rate.
Authors, year
Level of
evidence
N of
patients
Male
(%)
Age mean
(range)
N of upper limb
fasciotomies
N of lower limb
fasciotomies
Success
rate (%)
Barnea et al., 2006 IV 16 81 40 (21–74) 5 11 88
Caruso et al., 1997 IV 2 0 21.5 (0.92–42) 2 0 100
Janzing et al., 2001 III 5 NR NR (NR) NR NR 60
McKenney et al., 1996 IV 13 100 NR (16–45) NR NR 100
Medina et al., 2008 III 8 88 33 (25–43) 8 0 100
Singh et al., 2008 IV 11 NR NR (NR) 0 11 91
Taylor et al., 2003 IV 5 60 48 (28–83) 3 3 100
Wiger et al., 2000 IV 16 88 37 (16–86) 2 11 100
N: number; NR: not reported.
Table 3. Studies evaluating vacuum-assisted closure, demographics, and success rate.
Author, year
Level of
evidence
N of
patients
Male
(%)
Age mean
(range)
N of upper limb
fasciotomies
N of lower limb
fasicotomies
Success
rate (%)
Gabriel et al., 2009 IV 3 NR 14 (10–15) 0 3 67
Kakagia et al., 2012 II 25 NR 34.9 (18–54) 0 42 86
Saziye et al., 2011 III 7 71 61.4 (39–79) 1 6 71
Weiland et al., 2007 IV 3 100 23 (16–36) 0 4 67
Yang et al., 2006 III 34 NR NR (NR) 0 34 72
Zannis et al., 2009 III 249 NR 40.26 (NR) 68 370 79
N: number; NR: not reported.
Jauregui et al. 3
threading a vessel loop through the staples like a shoe-
lace.37 Several variations on this technique have been pro-
posed, such as the use of nylon sutures36,38 or subcuticular
K-wires39 instead of a vessel loop in the same shoelace
pattern. Govaert and van Helden proposed a similar tech-
nique utilizing several Ty-Raps (Thomas & Betts, Mem-
phis, Tennessee, USA), which are stapled to the skin and
individually tightened each day.40 Gradual suture
Table 4. Studies evaluating gradual suture approximation, complications.
Author, year
Complications
Necrosis, % (n) Limited motion, % (n) Infection, % (n) Amputation, % (n) Other, % (n)
Asgari et al., 2000 0 0 0 0 0
Chiverton et al., 2000 0 0 0 0 17 (1)
Cohn et al., 1986 0 0 0 0 0
Eid et al., 2012 0 0 0 0 0
Govaert et al., 2010 0 0 15 (2) 0 0
Harris et al., 1993 0 0 0 0 0
Janzing et al., 2001a 0 0 0 0 0
Janzing et al., 2001b 0 0 0 0 0
Kakagia et al., 2012 0 0 16 (4) 0 24 (6)
Ozyurtlu et al., 2014 20 (1) 0 0 0 0
Walker et al., 2012 NR 0 0 23 (16) 0
Zorilla et al., 2005 0 5 (1) 0 0 0
N: number; NR: not reported.
aand breported twice due to different variations in closure technique, conventional (a) versus intracutaneous (b).
Table 5. Studies evaluating dynamic dermatotraction, complications.
Author, year
Complications
Wound edge necrosis,
% (n)
Weakness, %
(n)
Neurologic deficit,
% (n)
Infection, %
(n)
Amputation, %
(n)
Delayed bone healing,
% (n)
Barnea et al.,
2006
0 0 0 6 (1) 0 0
Caruso et al.,
1997
0 0 50 (1) 0 0 0
Janzing et al., 2001 40 (2) 40 (2) 0 0 0 40 (2)
McKenney et al.,
1996
0 0 0 8 (1) 0 0
Medina et al.,
2008
0 0 25 (2) 0 0 0
Singh et al., 2008 0 0 0 0 9 (1) 0
Taylor et al., 2003 0 0 0 0 0 0
Wiger et al., 2000 13 (2) 0 0 0 0 0
N: number.
Table 6. Studies evaluating vacuum-assisted closure, complications.
Author, year
Complications
Wound edge necrosis, % (n) Neurologic deficit, % (n) Infection, % (n)
Gabriel et al., 2009 0 0 0
Kakagia et al., 2012 0 0 24 (6)
Saziye et al., 2011 0 0 0
Weiland et al., 2007 33 (1) 33 (1) 0
Yang et al., 2006 0 0 0
Zannis et al., 2009 0 0 0
N: number.
4 Journal of Orthopaedic Surgery 25(1)
approximation techniques generally have low costs, as they
use inexpensive materials that are generally readily
available.
Dynamic dermatotraction
Several different proprietary devices have been used to close
fasciotomy wounds by applying continuous tension to the
wound edges until they can be closed by DPC, which are
classified as ‘‘dynamic dermatotraction devices’’ by Kakagia
et al.1 These devices are described in Table 7. One major
drawback to these devices is the significant costs, which can
be US$500–US$1000 per device.41
Vacuum-assisted closure
Vacuum-assisted closure (VAC; Kinetic Concepts, Inc.,
San Antonio, Texas, USA) therapy involves use of a foam
dressing, covered by an adhesive drape, which is connected
to a vacuum pump in order to create sub-atmospheric pres-
sure on the wound, until the wound edges are approximated
enough to permit DPC.35 This process, known as negative
pressure wound therapy (NPWT), removes excess fluid,
thus reducing edema and ideally accelerating wound heal-
ing.1 VAC therapy may also decrease bacterial count and
stimulate angiogenesis.50 The equipment required for VAC
costs approximately US$96.51 per day.51
Results
In total, we evaluated 23 studies with a total of 606 patients,
ranging in age from 0.92 to 95 years, who underwent 118
upper compartment and 621 lower compartment fascio-
tomies.1,5,35,37,38,40,41,43–49,52–60 Tables 1–3 display the
demographic information of the included patients.
Dynamic dermatotractionhad the highest success rate at
92.7% (95% confidence intervals (CI) of 85.1 to 97.7%), as
shown in Figure 2. Gradual suture approximation followed
with a success rate of 92.4% (95% CI of 79.8 to 99.1%), as
shown in Figure 3. VAC had the lowest success rate of
78.1% (95% CI of 74.6 to 81.4%), as shown in Figure 4.
In terms of complications following wound closure,
VAC had the lowest rate of 2.49% (8 of 321 closures). This
was followed by gradual suture approximation, with a com-
plication rate of 14.83% (31 of 209 closures). The highest
complication rate was observed with dynamic dermatotrac-
tion, in which 18.4% of the limbs developed a complication
(14 of 76 closures). The specific details of the complica-
tions observed with different methods are displayed in
Tables 4–6.
Discussion
There is no consensus in the literature regarding the best
method for the closure of fasciotomy wounds in ACS. Dif-
ferent techniques carry their own inherent complications.7,8
Table 7. Dynamic dermatotraction devices.
Name (manufacturer) Technique
Sure-Closure (Life Medical Sciences, Princeton, NJ,
USA)41,42
Skin-stretching system that incrementally increases the tension across the
wound for 30–90 min at a time until DPC can be achieved
Suture Tension Adjustment Reel (STAR, WoundTEK
Inc., Newport, RI, USA)43
Skin-stretching system attached to the edges of the wound to permit gradual
daily tightening for several days until DPC can be achieved
Silver Bullet Wound Closure Device (SBWCD,
Boehringer Laboratories, Norristown, PA, USA)44
Device that is sutured into the middle of the wound and tightened daily until
DPC is completed
Canica dynamic wound closure device (Canica Design,
Inc., Almonte, ON, Canada)45,46
Cleated or adhesive skin anchors laced together with silicone elastomers,
which can be individually tightened, allowing for constant tension over the
entire wound until DPC is achieved
External Tissue Extension technique (ETE, Life Medical
Sciences, Princeton, NJ, USA)47
Silicone bands applied across the wound through plastic devices placed on
either side of the wound and tightened until DPC is achieved
Wisebands wound closure device (Wisebands Company
Ltd, Misgav, Israel)48
Skin-stretching device that measures the tension on the wound edges and
adjusts accordingly to maintain an appropriate level of tension
Marburger skin approximation system49 Plates placed along the sides of the wound joined by sutures and
progressively tightened until DPC is completed
Figure 2. Proportion of patients who achieved closure with
dynamic dermatotraction.
Jauregui et al. 5
In addition, the underlying mechanisms of injury leading to
the compartment syndrome may result in further wound-
related complications and may result in amputation or
death. The purpose of this study was to systematically
review the current literature to assess the current evidence
regarding fasciotomy closure techniques. After evaluating
23 studies, we were able to determine that the highest suc-
cess rate was observed for dynamic dermatotraction (93%)
and gradual suture approximation (92%), followed by VAC
(78%). However, VAC had the lowest complication rate
(2%), followed by gradual suture approximation (15%),
and then dynamic dermatotraction (18%).
There are several limitations to this study. Many of the
studies were case series with small sample sizes. Small sam-
ples sizes are due to a number of factors, including the hetero-
geneity of the patient populations in each study. This is partly
due to the fact thatACS is causedbymany factors, resulting in
surgeons reporting their outcomes based on a wound closure
technique employed on a mixed patient population.
Even for those studies with larger sample sizes, many
were retrospective and/or uncontrolled. Study designs may
have contributed to this bias. For example, larger or more
severe wounds may have been closed more commonly with
one technique over another, leading to higher failure or
complication rates for that technique. For similar reasons,
we were unable to determine if there is a correlation
between mechanism of injury and risk of complications.
For example, amputations following fasciotomy closure are
generally due to the underlying mechanism of injury that
precipitated the compartment syndrome, rather than the
closure method itself. Thus, more severe mechanisms of
injury that are more likely to result in amputation would
be expected to have higher complication rates, regardless of
the closure method. This could not be separately analyzed
here due to lack of individual patient data. In addition, due
to the lack of studies supporting the use of static tension
techniques with plaster strips or Steri-Strips (3 M Surgical
Products, St Paul, Minnesota, USA), these were not eval-
uated in this study.3,15,61
Currently, there are many surgeons who prefer VAC
systems. In this meta-analysis, these systems had the lowest
success rate but also had the lowest complication rate. In
our study, defining success as closure without STSG may
not be an accurate representation of what a surgeon deems
successful, following a severe extremity injury requiring
fasciotomies. Furthermore, in a patient who is already at
high risk for complications due to the severe nature of the
injury that lead to ACS, VAC systems may be the best
choice. The choice of using a VAC system, however, also
depends on the resources available, as these systems are
expensive. Whether this up-front expense is a cost-
effective means to avoid complications is outside the scope
of this study.
Conclusion
Following a fasciotomy, wound closure is a topic that is
controversial. The preference of the orthopedic commu-
nity for one technique over another varies over time, is
influenced by the availability of resources, and institu-
tional familiarity with certain techniques. We believe
that the ultimate decision should be individually based,
according to the specific clinical situation. The purpose
of our study was never to recommend one device over
another. However, when primary closure is the main
goal, devices that produce dynamic dermatotraction
could be beneficial. When the patient is at high risk for
complications, vacuum-assisted systems may be a better
alternative.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Figure 4. Proportion of patients who achieved closure with
vacuum-assisted closure (VAC).
Figure 3. Proportion of patients who achieved closure with
gradual suture approximation.
6 Journal of Orthopaedic Surgery 25(1)
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
1. Kakagia D, Karadimas EJ, Drosos G, et al. Wound closure of
leg fasciotomy: comparison of vacuum-assisted closure ver-
sus shoelace technique. A randomised study. Injury 2014;
45(5): 890–893.
2. Jensen SL and Sandermann J. Compartment syndrome and
fasciotomy in vascular surgery. A review of 57 cases. Eur J
Vasc Endovasc Surg 1997; 13(1): 48–53.
3. Weissman O, Goldman N, Stavrou D, et al. Adhesive skin
closure technique for closure of fasciotomy wounds in pedia-
tric patients: a case series. Wounds 2015; 27(5): 118–222.
4. Bengezi O and Vo A. Elevation as a treatment for fasciotomy
wound closure. Can J Plast Surg 2013; 21(3): 192–194.
5. Zannis J, Angobaldo J, Marks M, et al. Comparison of fas-
ciotomy wound closures using traditional dressing changes
and the vacuum-assisted closure device. Ann Plast Surg 2009;
62(4): 407–419.
6. Tiwari A, Haq AI, Myint F, et al. Acute compartment syn-
dromes.Br J Surg 2002; 89(4): 397–412.
7. Ojike NI, Roberts CS, and Giannoudis PV. Compartment
syndrome of the thigh: a systematic review. Injury 2010;
41(2): 133–136.
8. Velmahos GC, Theodorou D, Demetriades D, et al. Compli-
cations and nonclosure rates of fasciotomy for trauma and
related risk factors. World J Surg 1997; 21(3): 247–252.
9. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting
items for systematic reviews and meta-analyses: the PRISMA
statement. Ann Intern Med 2009; 151(4): 264–9, w64.
10. Basse PN, Lohmann M, Alsbjorn BF, et al. Split skin grafting
of defects from fasciotomy after compartment syndrome.
Acta Orthop Belg 1993; 59(1): 57–59.
11. Duman H, Kulahci Y, and Sengezer M. Fasciotomy in crush
injury resulting from prolonged pressure in an earthquake in
Turkey. EMJ 2003; 20(3): 251–252.
12. Johnson SB, Weaver FA, Yellin AE, et al. Clinical results of
decompressive dermotomy-fasciotomy. Am J Surg 1992;
164(3): 286–290.
13. Addison PD, Lannon D, and Neligan PC. Compartment syn-
drome after closure of the anterolateral thigh flap donor site: a
report of two cases. Ann Plast Surg 2008; 60(6): 635–638.
14. Van der Velde M and Hudson DA. VADER (vacuum-assisted
dermal recruitment): a new method of wound closure. Ann
Plast Surg 2005; 55(6): 660–664.
15. Harrah J, Gates R, Carl J, et al. A simpler, less expensive
technique for delayed primary closure of fasciotomies. Am J
Surg 2000; 180(1): 55–57.
16. Dente CJ, Feliciano DV, Rozycki GS, et al. A review of upper
extremity fasciotomies in a level I trauma center. Am Surg
2004; 70(12): 1088–9103.
17. Dover M, Memon AR, Marafi H, et al. Factors associated
with persistent sequelae after fasciotomy for acute
compartment syndrome. J Orthop Surg (Hong Kong) 2012;
20(3): 312–315.
18. Papalambros EL, Panayiotopoulos YP, Bastounis E, et al.
Prophylactic fasciotomy of the legs following acute arterial
occlusion procedures. Int Angiol 1989; 8(3): 120–124.
19. Ramos C,Whyte CM, and Harris BH. Nontraumatic compart-
ment syndrome of the extremities in children. J Pediatr Surg
2006; 41(12): e5–e7.
20. Bae DS, Kadiyala RK, and Waters PM. Acute compartment
syndrome in children: contemporary diagnosis, treatment,
and outcome. J Pediatr Orthop 2001; 21(5): 680–688.
21. Boxer L and Buchman S. An alternative method for closure of
fasciotomy wounds: Healing by secondary intention. Internet
J Plast Surg 2002; 1(2): 1–6.
22. Duckworth AD, Mitchell SE, Molyneux SG, et al. Acute
compartment syndrome of the forearm. J Bone Joint Surg
Am 2012; 94(10): e63.
23. Geary N. Late surgical decompression for compartment syn-
drome of the forearm. J Bone Joint Surg Br 1984; 66(5):
745–748.
24. Gelberman RH, Garfin SR, Hergenroeder PT, et al. Compart-
ment syndromes of the forearm: diagnosis and treatment. Clin
Orthop Relat Res 1981; 161: 252–261.
25. Klasson SC and Vander Schilden JL. Acute anterior thigh
compartment syndrome complicating quadriceps hematoma.
Two case reports and review of the literature. Orthop Rev
1990; 19(5): 421–427.
26. Mubarak SJ, Owen CA, Hargens AR, et al. Acute com-
partment syndromes: diagnosis and treatment with the aid
of the wick catheter. J Bone Joint Surg Am 1978; 60(8):
1091–1095.
27. Peters CL and Scott SM. Compartment syndrome in the fore-
arm following fractures of the radial head or neck in children.
J Bone Joint Surg Am 1995; 77(7): 1070–1074.
28. Roberts RS, Csencsitz TA, and Heard CW Jr. Upper extre-
mity compartment syndromes following pit viper envenoma-
tion. Clin Orthop Relat Res 1985; 193: 184–188.
29. Rogers GF, Maclellan RA, Liu AS, et al. Extremity fasciot-
omy wound closure: comparison of skin grafting to staged
linear closure. J Plast Reconstr Aesthet Surg 2013; 66(3):
e90–e91.
30. Seiler JG 3rd, Valadie AL 3rd, Drvaric DM, et al. Perio-
perative compartment syndrome. A report of four cases. J
Bone Joint Surg Br 1996; 78(4): 600–602.
31. Shall J, Cohn BT, and Froimson AI. Acute compartment
syndrome of the forearm in association with fracture of the
distal end of the radius. Report of two cases. J Bone Joint
Surg Br 1986; 68(9): 1451–1454.
32. Tarlow SD, Achterman CA, Hayhurst J, et al. Acute compart-
ment syndrome in the thigh complicating fracture of the
femur. A report of three cases. J Bone Joint Surg Br 1986;
68(9): 1439–1443.
33. Wiger P, Tkaczuk P, and Styf J. Secondary wound closure
following fasciotomy for acute compartment syndrome
increases intramuscular pressure. J Orthop Trauma 1998;
12(2): 117–121.
Jauregui et al. 7
34. Winternitz WA Jr, Metheny JA, and Wear LC. Acute com-
partment syndrome of the thigh in sports-related injuries not
associated with femoral fractures. J Bone Joint Surg Br 1992;
20(4): 476–477.
35. Saziye K, Mustafa C, Ilker U, et al. Comparison of vacuum-
assisted closure device and conservative treatment for fas-
ciotomy wound healing in ischaemia-reperfusion syndrome:
preliminary results. Int Wound J 2011; 8(3): 229–236.
36. Almekinders LC.Tips of the trade #32. Gradual closure of
fasciotomy wounds. Orthop Rev 1991; 20(1): 82–84.
37. Cohn BT, Shall J, and Berkowitz M. Forearm fasciotomy for
acute compartment syndrome: a new technique for delayed
primary closure. Orthopedics 1986; 9(9): 1243–1246.
38. Chiverton N and Redden JF. A new technique for delayed
primary closure of fasciotomy wounds. Injury 2000; 31(1):
21–24.
39. Callanan I and Macey A. Closure of fasciotomy wounds. A
technical modification. J Hand Surg Br 1997; 22(2): 264–265.
40. Govaert GA and van Helden S. Ty-raps in trauma: a novel
closing technique of extremity fasciotomy wounds. J Trauma
2010; 69(4): 972–975.
41. Caruso DM, King TJ, Tsujimura RB, et al. Primary closure of
fasciotomy incisions with a skin-stretching device in patients
with burn and trauma. J Burn Care Rehabili 1997; 18(2):
125–132.
42. Narayanan K, Latenser BA, Jones LM, et al. Simultaneous
primary closure of four fasciotomy wounds in a single setting
using the Sure-Closure device. Injury 1996; 27(6): 449–451.
43. McKenney MG, Nir I, Fee T, et al. A simple device for
closure of fasciotomy wounds. Am J Surg 1996; 172(3):
275–277.
44. Medina C, Spears J, and Mitra A. The use of an innovative
device for wound closure after upper extremity fasciotomy.
Hand (NY) 2008; 3(2): 146–151.
45. Singh N, Bluman E, Starnes B, et al. Dynamic wound closure
for decompressive leg fasciotomy wounds. Am Surg 2008;
74(3): 217–220.
46. Taylor RC, Reitsma BJ, Sarazin S, et al. Early results
using a dynamic method for delayed primary closure of
fasciotomy wounds. J Am College Surg 2003; 197(5):
872–878.
47. Wiger P, Blomqvist G, and Styf J. Scand J Plast Reconstr
Surg Hand Surg 2000; 34(4): 315–320.
48. Barnea Y, Gur E, Amir A, et al. Delayed primary closure of
fasciotomy wounds with Wisebands, a skin- and soft tissue-
stretch device. Injury 2006; 37(6): 561–566.
49. Janzing HM and Broos PL. Dermatotraction: an effective tech-
nique for the closureof fasciotomywounds: a preliminary report
of fifteen patients. J Orthop Trauma 2001; 15(6): 438–441.
50. Morykwas MJ, Argenta LC, Shelton-Brown EI, et al.
Vacuum-assisted closure: a new method for wound control
and treatment: animal studies and basic foundation. Ann
Plast Surg 1997; 38(6): 553–562.
51. Webster J, Scuffham P, Stankiewicz M, et al. Negative pres-
sure wound therapy for skin grafts and surgical wounds heal-
ing by primary intention. Cochrane Database Syst Rev 2014;
10: Cd009261.
52. Asgari MM and Spinelli HM. The vessel loop shoelace tech-
nique for closure of fasciotomy wounds. Ann Plast Surg
2000; 44(2): 225–229.
53. Eid A and Elsoufy M. Shoelace wound closure for the man-
agementof fracture-related fasciotomy wounds. ISRN Orthop
2012; 2012: 528382.
54. Gabriel A, Heinrich C, Shores J, 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(11): 1428–1436.
55. Harris I. Gradual closure of fasciotomy wounds using a vessel
loop shoelace. Injury 1993; 24(8): 565–556.
56. Ozyurtlu M, Altinkaya S, Baltu Y, et al. A new, simple tech-
nique for gradual primary closure of fasciotomy wounds.
Ulus Travma Acil Cerrahi Derg 2014; 20(3): 194–198.
57. Walker T, Gruler M, Ziemer G, et al. The use of a silicon
sheet for gradual wound closure after fasciotomy. J Vasc Surg
2012; 55(6): 1826–1828.
58. Weiland DE. Fasciotomy closure using simultaneous
vacuum-assisted closure and hyperbaric oxygen. Am Surg
2007; 73(3): 261–266.
59. Yang CC, Chang DS, and Webb LX. Vacuum-assisted clo-
sure for fasciotomy wounds following compartment syn-
drome of the leg. J Surg Orthop Adv 2006; 15(1): 19–23.
60. Zorrilla P, Marin A, Gomez LA, et al. Shoelace technique for
gradual closure of fasciotomy wounds. J Trauma 2005; 59(6):
1515–1517.
61. Mbubaegbu CE and Stallard MC. A method of fasciotomy
wound closure. Injury 1996; 27(9): 613–615.
8 Journal of Orthopaedic Surgery 25(1)
View publication statsView publication stats