Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases

Abstract

Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.

Mechanical properties of hybrid sisal/coir fibers reinforced polylactide biocomposites

“…Plant fibers such as kenaf, flax, bamboo, sisal, hemp, and jute have lots of advantages over synthetic or man-made fibers, including low cost, recyclability, smaller carbon footprint, and biodegradability [12][13][14][15]. They also offer satisfactory performance of the mechanical properties when they are mixed with polymer, leading to both economic and environmental benefits [13,[16][17][18][19][20]. The main chemical components of natural fibers are cellulose, hemicellulose, lignin, and a small amount of extractives.…”

Cierre de heridas y fasciotomias. Técnica cuerda de arco

“…(11)(12)(13) Pocos trabajos describen la utilización de clavos de Kirschner para el cierre de un defecto de cobertura. Encontramos una publicación para cierre de cuero cabelludo, a propósito de un caso, del año 2012 en Malasia (14) y otra mediante la técnica denominada Dermotaxis, (15) que utiliza clavos de Kirschner interconectados por un dispositivo que provoca compresión gradual.…”

“…Aprovechamos para ello el efecto biomecánico de los clavos de Kirschner y las propiedades viscoelásticas de la piel descritas por Gibson en 1977 (16) donde describe: -Fluencia: deformación que se produce en la piel cuando se encuentra sometida a una tensión constante -Propiedad de relajación de stress: referida a la capacidad de la piel humana de estirarse permanentemente siempre que la fuerza aplicada sea meticulosamente controlada para evitar el daño. (15,16) Nos basamos también en la cualidad de los tejidos por la que al ser sometidos a expansión sufren adelgazamiento y aumento de su vascularización; un ejemplo claro se presenta en la piel del abdomen durante el embarazo, en la obesidad y cuando se aplican dispositivos expansores de piel. En estos casos se puede observar que la piel conserva su color y textura.…”

Dermotraction as a Simple and Effective Technique for Fasciotomy Wound Closure.

“…Split Skin grafting is conventionally done to cover the herniated muscles. However, Split-thickness skin grafting results in a thin, insensate and unsightly scar which has limited capacity of tolerating friction to (19) which normal skin of lower limb is exposed . It required additional surgery under general anesthesia, pain at graft donor site, infection, risk of graft non-14 adherence and cosmetic problem.…”