Retracted Skin Defect Closure
Increased intra-compartmental pressures seen in compartment syndrome often leave difficult to close wounds. Historically, surgeons have utilized a combination of vessel loops and staples, or other techniques, in order to loosely close fasciotomy sites too retracted to close primary. This method of closure, however, was not without complication, and required surgeon experience to properly tie and employ. As a result, companies have begun marketing products specifically for use on retracted skin or wounds under too much tension to close primarily.
Gold standard treatment of compartment syndrome is emergent fascial release (fasciotomy). There is no role for nonoperative management of true compartment syndrome. Fascial release allows for restoration of perfusion, and can halt muscle death and neural compression from progressing further. In the setting of bleeding disorders, or other identifiable and reversible causes, medical co-management is employed after fascial release has been performed. It is important that fascial release is complete and timely, as incomplete release can lead to further tissue damage.
Compartment syndrome is one of the few true orthopaedic emergencies. Characterized by increased osseofascial compartment pressures leading to subsequent decreased perfusion and blood flow, this condition can lead to rapid muscle death. As a result of this muscle death, patients can suffer from a variety of outcomes to include loss of function, neurological deficits or even infection and eventual amputation. The most common cause of compartment syndrome is concomitant fracture, specially of the tibial shaft and distal radius. There are other causes as well, to include tight casts, gunshot wounds, IV fluid extravasation, burns or bleeding disorders.
The ACell ABRA Surgical™ provides subcutaneous traction for open and/or retracted wounds. It employs chronic cyclic tension to close wounds, and can obviate the need for skin grafting and associated rehabilitation, pain and loss of function. Two main products are offered, one based upon skin anchors, and the other which utilizes an adhesive dressing. Size of defect and amount of closure needed can dictate which product is best. These products allow for controlled closure of wounds under tension, and are perfect when skin closure following fasciotomy is impossible.
The ACell ABRA™ is the first product of its type. Traditionally, fasciotomy sites were closed utilizing a combination of vessel loops or subcutaneous sutures, all of which were available off of the shelf in hospitals.