Optimising Wound Closure Following a Fasciotomy: A narrative review.

Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and non-infected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient's condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.

Hand Function Deficiency in Patients with Dupuytren's Disease and Course of Recovery after Palmar Fasciectomy.

PURPOSE OF THE STUDY To evaluate hand function deficiency in patients with Dupuytren's disease (DD) in addition to assessing the improvement of function after palmar fasciectomy by using different hand-related questionnaires. MATERIAL AND METHODS A total of 121 hands (95 patients) underwent surgery. Disease severity was designated using Tubiana's Staging System. The Tendency of changes of Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Patient Evaluation Measure (PEM), and Hand Function Score (HFS) scores of patients with DD undergoing palmar fasciectomy were assessed prior to, 3 months after, and 1 year after the operation. Moreover, total loss of extension (TLoE) was evaluated using a goniometer in the same time intervals. Repeated measure ANOVA Friedman's test were used. Responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS The results showed statistically significant improvement of the originally obtained questionnaire results after 3 months for DASH and HFS and 12 months for all forms; only the PEM and DASH score significantly changed between 3 and 12 months. TLoE before surgery was 144.1 o ±99.6 o ; 3-month and 1-year after surgery: 14.3 o ±58.0 o and 19.3 o ±34.7 o respectively. SRMs for 1 year after surgery was large for PEM (1.11) and medium for DASH (0.7) and HFS (0.79). CONCLUSIONS DASH, PEM, and HFS are valuable tools to monitor the hand function of patients with DD after surgery. Key words:hand function, Dupuytren's disease, palmar fasciectomy.

Outcome of a Specific Compartment Fasciotomy Versus a Complete Compartment Fasciotomy of the Leg in One Patient With Bilateral Anterior Chronic Exertional Compartment Syndrome: A Case Report.

Chronic exertional compartment syndrome of the leg is a debilitating lower extremity condition in which increased intracompartmental pressure impedes blood flow to the involved compartments of the distal lower extremity, resulting in ischemia and pain. Owing to the lack of success with conservative management, most surgeons perform complete release fasciotomy as the preferred method of fasciotomy to avoid an unsuccessful release or outcome. Studies have been performed regarding the outcomes of complete compartmental release versus specific compartmental release, but no study has been performed comparing complete fasciotomy and compartment-specific fasciotomy in a single patient. The purpose of the present case report was to compare the efficacy of a complete fasciotomy versus a specific fasciotomy in 1 patient with properly diagnosed bilateral anterior compartment chronic exertional compartment syndrome with an 18-month follow-up period. The Lower Extremity Functional Scale and both subscales of the Foot and Ankle Ability Measure were administered to assess the functional outcomes. Circumferential measurements and range of motion photographs were taken to compare the objective data throughout the recovery process. In general, the range of motion, circumferential measurements, and functional outcome measure scores were better for the specific compartmental fasciotomy leg than for the complete fasciotomy leg during the recovery period. The overall functional outcomes were the same for both surgical approaches, with the specific fasciotomy leg returning to baseline function 13 to 23 days before the complete fasciotomy leg. The outcomes remained unchanged 18 months after surgery.