| 1.1.Background: Acute compartment syndrome(ACS)is a traumatic pathology that requires emergency surgery.Urgent fasciotomy is the gold standard to reduce the intracompartmental pressure and prevent muscle and nerve necrosis.After incision there is a task: how to close a wound whose potential size is dictated by increased pressure and swelling of the tissues.In the literature was well described and in our own practice evaluated the method of covering wounds by vacuum sealing drainage(VSD)as perspective intermediate stage to managing wound after fasciotomy and relieve edema.Along with the traditional methods of closing wounds,such as a delayed primary suture or split thickness skin grafting(STSG),new technologies are entering the age of innovation,using the example of the new skin stretching device invented by Prof.Wilhelm Fleischmann(EASApprox?,Bayerisch China Science and Technology Development Co.).In the majority cases resorting to covering by traditional methods,the wound closes at still high pressure and as a result,poor blood tissues supply,which leads the risk of transplant skin necrosis,as well as a number of other shortcomings possible complications,such as infection,prolongation time to recover the wound,hospitalisation days and high cost.The purpose of this study is to compare the treatment outcome of a new skin stretching device with needles and rod with that of the traditional treatment to covering wound in patients undergoing fasciotomy in the ACS 1 and 2 stage in the forearm or calf.1.2.Patients and Methods: Retrospective statistical analysis,from the First Affiliated Hospital of Dalian Medical University in the period since August 2015 to January 2018,we collected 34 patients performed fasciotomy.Thus resorting of exclusion and inclusion criteria,24 patients with acute compartment syndrome1 or 2 stage of the upper or lower extremity and approximately the same size of the wound after fasciotomy were selected.All patients underwent either traditional treatment(primary suture or split thickness skin grafting,n=14,group T)or new method(EASApprox? skin stretching device with needles and rod,n=8,group N)when the pressure of fasciotomy wounds were released and stabilized.To avoid a number of flaws and bias control in the study design we resorted to a statistical propensity score matching test.Matching attempts to mimic randomization.Thus,8 patients were selected from each comparison groups.All of the patients had high tension in the wound with positive Pinch Test before the incision was closed.In this study,we evaluated the efficacy treatment of these two groups.In group N,there were all patients achieved extra skin to close wounds by providing devicese to do several alternative cycles of stretching and relaxation.Meanwhile,3 patients in group T were managed to close the wound by delayed primary suture and 7 patients were applied split thickness skin grafting.The maximum width of fasciotomy wound while undergoing Pinch Test,incident of infection,necessity of applied skin grafting,necrosis of transplanted skin and days of recovery were data collected and statistically assessed.The maximum wound width,incident of infection,necrosis of skin,days of recovery and etc.were data collected by an independent wound care specialist nurse and forwarded to be statistically assessed.1.3.Results: Through the study of the statistical comparison of all patient data in group(N): there were 6 males and 2 females aged 20-55 years old,with an average age(mean ± SD 41.50±13.36).The maximum width of fasciotomy wound while undergoing Pinch Test was from 3.4 to 7.7 cm(mean±SD,4.27±1.11).The tension indicating scales of the device showed that the original tension at the onset of stretching was high in all 8 wounds.The final tension in wounds by suturing were all low.The wounds were closed by two stage stretching.7 wounds achieved primary closure and 1 wound was closed by two stage stretching.Meanwhile,the group T included 8 patients: 7 males and 1 females,aged from 25 to 65 years old(mean ± SD 40.13±12.22).The maximum width of fasciotomy wound was from 3.5 to 7.5 cm(mean ± SD,4.17±0.9).3 patients were achieved to close the wounds by delayed primary suture,5 patiens were managed by STSG.There were no statistically significant differences between group N and group T about incident of infection(P=0.131),maximum width of wounds(P=0.221)and days of wound recovery(P=0.396).However,the analysis of the margins necrosis of wound inferred that the patients in group N(0/8=0%)more likely to avoid necrosis than the group T(3/8=37.5%)(P<0.045).The analysis of the forced using skin grafting conclude that the patients in group T(5/8=62.5%)was treated in more cases that in the group N(0/8=0%)(P<0.007).1.4.Conclusions: This device may represent a move forward in the attempt to avoid a numbers of cases treathed by traditional method and therefore a myriad complications such as necrosis of margins that can follow split thickness skin grafting.This technology represented byself as a minimally invasive simple operation using viscoelasticity properties of skin in closing fasciotomy wounds. |
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