The Use of an Innovative Device for Wound Closure after Upper Extremity Fasciotomy

Abstract

Introduction The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. Materials and Methods A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). Results Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days).Conclusions We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a secondstage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.

Shoe lace technique, a simple and less expensive method for Fasciotomy wound closure following compartment syndrome

“…This could be explained by the fact that the delay in performing fasciotomy following injury resulted in excessive soft tissue swelling and edema which interfered in closure thus increasing the closure time in such cases. With regards to the duration of gradual primary closure of fasciotomy wound our result were found to be similar to other studies which were conducted using various dermal apposition devices [7,10,11] . In our study, the mean duration of closure was found to be 8.31 days (range 6-15 days).…”

“…In the literature, there is plethora of innovative techniques and variations focusing on dermal apposition which take advantage of elastic property of skin for delayed primary closure of fasciotomy wound. These include the vessel loop shoe lace technique, sub cuticular suture, Ty -Raps, sure closure, Dynamic wound closure, STAR and Silver Bullet Wound Closure Device [7][8][9][10][11] . Fasciotomy wound closure using vessel loop or shoe lace technique has been described as a viable management [5,7,[12][13][14][15][16] .…”

A new, simple technique for gradual primary closure of fasciotomy wounds

“…[1][2][3][4][5][6][7][8][9][10][11][12] Some of them included methods that were produced as a result of revising the equipment used in routine surgical practice, while others included techniques using specifically designed devices for dermotraction. The described methods were reported to yield successful outcomes.…”

“…[1][2][3][4] In the series by Taylor et al, Zorrilla et al, Medina et al, and Govaert et al, mean delayed closure time was reported as 6.3 -9.8 days. In our study, the mean duration of closure was found to be 8.6 days.…”

“…[1][2][3][4] The impossibility of primary closure in the early period following fasciotomy due to edema or wound tightness and possible long-term complications of skin grafting have led investigators to search for new methods with better outcomes both cosmetically and functionally.…”