Use of Continuous External Tissue Expanders for Fasciotomy Closure

Abstract

Introduction and Objectives Revascularization of traumatic arterial injuries and acute arterial occlusions of the extremities with significant ischemia time often develop compartment syndrome requiring fasciotomy. Many of these open wounds heal by secondary intention due to edema limiting delayed primary closure. They can involve the expense of negative pressure wound therapy (NPWT) and skin grafting. Continuous external tissue expanders (CETE) are a novel alternative for delayed fasciotomy closure. We report our early experience using CETE. Methods IRB approval was granted for retrospective review of patients undergoing emergency open revascularization for acute limb ischemia and traumatic arterial injury requiring fasciotomy and CETE. Data collected include patient demographics, location of arterial injury/occlusion, type of open bypass or repair, type of fasciotomy, and subsequent surgical management. Results We identified 37 patients undergoing emergency revascularization and fasciotomy in which CETE was used. The average age was 58 (20-87 years) and 68% (n=25) were male. 11% (n=4) of patients had traumatic arterial injury and 33 patients had open bypass surgery for acute limb ischemia. After CETE application, 78% (n=29) underwent delayed primary closure with staples, sutures or both, 11% (n=4) required grafting, 8% (n=3) required amputation due to vascular insufficiency, and 3% (n=1) required Integra application. The infection rate was 13.5% (n=5) including two patients with chronic systemic infections. Conclusions Our early experiences show a high rate of success in wound closure (78%) with a low rate of grafting (8%). The average time to wound closure was 4.8 days, which avoids long-term outpatient wound care. Based on our early success, we feel further study is indicated especially in the area of cost analysis between CETE and NPWT in fasciotomy wound closure