Primary Closure Of Large Skin Defects After Fasciotomy By Harnessing Of The Skin's Viscoelastic Properties

Objective: Through the research on the theory of the skin wound closing,to deeply understand the mechanism of action that the skin viscoelastic works on the closing of skin wound.Base on it,to study the clinic effect of new skin stretching device with hook needles and rod for primary closure of large skin defect after fasciotomy.Methods: From May to September in 2015,by using of the rod type skin expander,totally seven osteofascial compartment syndrome fasciotomy wound cases were treated,wherein two left forearm palm side,one right forearm palm side,one right volar dorsal forearm,and three left leg,a total of 7.The number of 6 people,including four male and two female.The average age of them is 39 years(20-55 years).All were injured in a traffic accident,3 cases with repaired vascular injury: One cases of brachial artery,popliteal artery.Two cases of osteofascial compartment syndrome.after the fascial incision decompression chamber syndrome operation,using vacuum sealing drainage(vacuum sealing,drainage,VSD)to close the wound coverage.From the operation till the wound coverage closed,the average time was 8 days(6-17 days),the maximum width of the original wound was average 5.0cm(3.3-6.3cm),and Pinch experimental wound closure were positive.On the condition that adequate anesthesia,wound debridement,pruning 2-3mm formation margin,both sides of the skin are not free.Using hands to push and make the edge of the skin wound closed(Pinch experiment),to preliminary judge whether the wound can be closed at low tension.With approximation of hook needles of skin stretching device,to expand the skin for 4 minutes,and relax for1 minute as a unit of cyclic stretch,and test the pulses in intraoperative monitoring.After cyclic stretch,using the visco elasticity of the skin to skin on both sides of the wound produced mechanical stretch,to realize the force relaxation.Tension indicator measuring wound closure tension are low scale,removal of the expander,suturing the wound closure at low tension.After the operation,postoperative observation of limb blood supply,and whether it have no limb swelling increased and compartment tension increased.Regular cleaning the wound and changing the medicine.Recording changes of the wound and healing time.Results: by the own tension indicating device of the application of closed tension rod type skin expander to measure skin wounds: showing that the initial closure tension before using all the wounds were all high tension indexs.what's more,Pinch tests were all positive.After the repeatly stretching of the rod type skin expander,the final closure of all the wounds were low tension indication scales and Pinch tests were negative,all wounds were closed.A low tension can be extended to 4 minutes and 1minutes of skin relaxation as a unit cyclic stretch and the average expander time was 60minutes(55-80 minutes).During the detection of skin expansion pulses,although weakened,but still palpable arterial pulsation;in skin relaxation,pulses were normal.During the operation,there was no deformation and crochet off,and the expander keptstable without loosening.what's more,there were no wound around Skin cutting injury.After the operation,there was no significant increased limb swelling and increased compartment tension.Artery pulsed strong and limb blood supply kept well without obvious sensorimotor disorder.6 cases were followed up for 3-7 months,averaging 4.5months.The cases showed that all wounds were healed.The average healing time was14 days.There were no skin edge necrosis and infection of incision and significant scar hyperplasia.Conclusion: pull rod type makes the skin stretched surrounding the wound through the effective use of viscosity and elasticity of skin,which contributes to gaining additional skin,the compartment decompression after tracheotomy wound can be a period of low tension closed,and to avoiding the traditional skin grafting,and second stage skin grafting brings risks and complications.The technique is minimally invasive and simply operated,providing a safe and effective method to close a larger wound.