Laura S Johnson1, Mitchell Chaar2, Chad G Ball3, Sebastian Perez4, Jeffrey M Nicholas5, Amy D Wyrzykowski6, Grace S Rozycki7, David V Feliciano8, Christopher J Dente9. 1. Medstar Washington Hospital Center, Washington, DC, United States; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: laura.s.johnson@medstar.net. 2. Jersey City Medical Center, Jersey City, NJ, United States; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: mitch_chaar@yahoo.com. 3. University of Calgary, Alberta, Canada; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: ball.chad@gmail.com. 4. Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: sdperez@emory.edu. 5. Gwinnett Medical Center, Lawrenceville, GA, Georgia; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: jnicholas@gwinnettmedicalgroup.com. 6. Wellstar Medical Group, Atlanta, GA, Georgia; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: amy.wyrzykowski@wellstar.org. 7. Indiana University, Indianapolis, IN, United States; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: grace.rozycki@att.net. 8. Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States; Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: davidfelicianomd@gmail.com. 9. Grady Memorial Hospital and Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: cdente@emory.edu.
Abstract
INTRODUCTION:Morbidity from the treatment of extremity compartment syndrome is underappreciated. Closure technique effectiveness has yet to be definitively established. METHODS: A randomized non-blinded prospective study was performed involving patients who underwent an extremity fasciotomy following trauma. Shoelace wounds were strapped with vessel loops under tension and VAC wounds were treated with a standard KCI VAC dressing. After randomization, patients returned to the OR every 96 h until primarily closed or skin grafted. RESULTS:21 patients were consented for randomization with 11 (52%) successfully closed at the first re-operation. After interim analysis the study was closed early with 5/5 (100%) of wounds treated with the shoelace technique closed primarily and only 1/9 (11%) of VAC wounds closed primarily (p = 0.003). Overall primary closure was achieved in 74% of patients. CONCLUSIONS: Aggressive attempts at wound closure lead to an increased early closure rate. For wounds that remain open after the first re-operation, a simple shoelace technique is more successful than a wound VAC for achieving same hospital stay skin closure.
RCT Entities:
INTRODUCTION: Morbidity from the treatment of extremity compartment syndrome is underappreciated. Closure technique effectiveness has yet to be definitively established. METHODS: A randomized non-blinded prospective study was performed involving patients who underwent an extremity fasciotomy following trauma. Shoelace wounds were strapped with vessel loops under tension and VAC wounds were treated with a standard KCI VAC dressing. After randomization, patients returned to the OR every 96 h until primarily closed or skin grafted. RESULTS: 21 patients were consented for randomization with 11 (52%) successfully closed at the first re-operation. After interim analysis the study was closed early with 5/5 (100%) of wounds treated with the shoelace technique closed primarily and only 1/9 (11%) of VAC wounds closed primarily (p = 0.003). Overall primary closure was achieved in 74% of patients. CONCLUSIONS: Aggressive attempts at wound closure lead to an increased early closure rate. For wounds that remain open after the first re-operation, a simple shoelace technique is more successful than a wound VAC for achieving same hospital stay skin closure.
Authors: Piia Suomalainen; Toni-Karri Pakarinen; Ilari Pajamäki; Minna K Laitinen; Heikki-Jussi Laine; Jussi P Repo; Ville M Mattila Journal: Scand J Surg Date: 2021-06-02 Impact factor: 2.360