Secondary wound closure following fasciotomy with the external tissue extender

Objective To observe the effects of the external tissue extender (ETE) for secondary wound closure following fasciotomy after acute compartment syndrome. Methods Twenty- one cases (age, 7－ 36 years old) following fasciotomy were treated with the ETE for secondary wound closure. The wounds occurred in the leg in 17 cases, the forearm in 3 and the foot in 1. The largest wound measured 11 cm× 28 cm, the smallest 5 cm× 15 cm. One case was accompanied with exposure of the tibia, and the other with tendon. Placement of the ETE was carried out at 4－ 7 days following fasciotomy. The secondary wound closure was done when the distance between the wound edges was smaller than 1 cm, usually at 3－ 7 days after the ETE procedure. Results The wounds healed in 20 cases without skin grafting, forming a line- like scar. In one case, part of the ETE had to be removed because of wound infection, and small skin grafting was done later. The wounds also healed well in those two cases with the exposure of the tibia and tendon after using the ETE. With 3－ 15 months follow- up, distant joints adjacent to the wounds showed good range of motion, without muscular contracture. Conclusion It is safe to use the ETE for secondary wound closure following fasciotomy after acute compartment syndrome. Wound closure with the ETE shows following advantages: 1) It is a simple, convenient and fast speed procedure, with a short stay of hospital and relatively low cost. 2) Skin graft is not needed, forming a line- like scar after healing. It shows good skin quality and cosmetic appearance. 3) The procedure is also suitable for those cases with exposure of bone or tendon.