D Kakagia1, E J Karadimas2, G Drosos3, A Ververidis3, G Trypsiannis4, D Verettas3. 1. Department of Plastic and Reconstructive Surgery, Democritus University in Thrace Hospital, Alexandroupolis, Greece. Electronic address: despoinakakagia@yahoo.com. 2. Department of Orthopedics, Democritus University in Thrace Hospital, Alexandroupolis, Greece; Department of Orthopedics, Hellenic Red Cross Hospital, Athens, Greece. 3. Department of Orthopedics, Democritus University in Thrace Hospital, Alexandroupolis, Greece. 4. Department of Medical Statistics, Democritus University in Thrace, Alexandroupolis, Greece.
Abstract
BACKGROUND: Fasciotomies, though essential for the prevention and management of compartment syndromes, may increase morbidity and prolong hospitalisation. Two widely applied methods of delayed primary closure are compared in leg fasciotomy wounds. PATIENTS AND METHODS: Two groups, each of 25 patients with leg fasciotomies due to fractures and soft tissue injuries, who were randomly assigned to be treated either by vacuumassisted closure (VAC®, n=42 wounds, group V) or by the shoelace technique (n=40 wounds, group S), were evaluated in this study. Wound length, time to definite closure, complications, need for additional interventions and daily treatment costs were data collected and statistically assessed. RESULTS:Wound closure time was significantly higher in group V compared to group S (p=0.001; 95% CI of the difference, 1.8-6.3 days). Five group V patients required split thickness skin grafts. In six group S patients, the vessel loops had to be replaced. The mean daily cost of negative pressure therapy alone was 135 euro (range 117-144 euro), whilst the mean daily cost of treatment for the shoelace technique was 14 euro ranging from 8 to 18 euro (p=<0.001). CONCLUSIONS: Both VAC® and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. VAC® requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.
RCT Entities:
BACKGROUND: Fasciotomies, though essential for the prevention and management of compartment syndromes, may increase morbidity and prolong hospitalisation. Two widely applied methods of delayed primary closure are compared in leg fasciotomy wounds. PATIENTS AND METHODS: Two groups, each of 25 patients with leg fasciotomies due to fractures and soft tissue injuries, who were randomly assigned to be treated either by vacuum assisted closure (VAC®, n=42 wounds, group V) or by the shoelace technique (n=40 wounds, group S), were evaluated in this study. Wound length, time to definite closure, complications, need for additional interventions and daily treatment costs were data collected and statistically assessed. RESULTS: Wound closure time was significantly higher in group V compared to group S (p=0.001; 95% CI of the difference, 1.8-6.3 days). Five group V patients required split thickness skin grafts. In six group S patients, the vessel loops had to be replaced. The mean daily cost of negative pressure therapy alone was 135 euro (range 117-144 euro), whilst the mean daily cost of treatment for the shoelace technique was 14 euro ranging from 8 to 18 euro (p=<0.001). CONCLUSIONS: Both VAC® and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. VAC® requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.
Authors: Amr Tawfik; Bryan Hozack; Justin Melendez; Bobby Varghese; Brian M Katt; Pedro Beredjiklian; Michael Nakashian Journal: Cureus Date: 2021-06-15