Delayed Primary Closure of Open Double Fasciotomy Wounds at Leg with “Pasha Device” A Novel Method

Abstract

Objective:  The objective of this study was to close open fasciotomy wounds using a new external fixation device. The principal behind this new development was based on dermotraction and Ilizarov traction rege-neration technique.

Study Design:  Descriptive study.

Place and Duration of Study:  This study was con-ducted in Combined Military Hospital Peshawar for a period of 6 months from September 2011.

Patients and Methods:  Nine patients with fasciotomy wounds were studied. A new skin External fixa-tion device was designed and manufactured from com-ponents of Ilizarov set. The name of device was given after the name of the first author “Pasha Device – PD” of Skin Traction Regeneration. The aim was to achieve delayed primary closure.

Results:  All of our patients were male. The average age was 30.3 years range 45 – 20. The aetiology was high energy bullet injury in 3, road traffic accidents in 5 and bomb blast splinters in 1. Tibia was affected in 5 cases, Femur in 3 and ankle 1 case. 7 patients had open fractures and 2 had closed. Fasciotomy was done at mean interval of 11.7 hours after injury range 23 – 2. The mean time between fasciotomy and application of Device was 5.22 days range 8-0. The mean length of fasciotomy was 19.4 cm range 24 – 17 and breadth 5.75 range 7 – 4.5.The fractures were fixed with AO fixators in 4 patients, Naseer Awais fixator in 3 and Ilizarov fixator in 2. Vacuum suction pack dressings (Vac – pack Dressing) were applied on individual basis in 4 patients. Delayed primary wound closure was possible in all 9 cases. The mean time for wound closure was 6.66 days range 8 – 5. We had 1 minor complication.

Conclusion:  We described a new technique to close fasciotomy wounds with dermotraction using “Pasha Device”. This is cheap, simple, user friendly and reli-able and will decrease the need for skin grafting for coverage of such wounds. The review of the interna-tional literature shows that the “Pasha Device” and technique of its application to close fasciotomy wou-nds is addition of new knowledge and technology in field of treatment of such defects.

Keywords:  Pasha Device, Fasciotomy wound, open fracture, Dermotraction.