Title: Comparison of Fasciotomy Wound Closures Using Single against Double incision, and Traditional Dressing Changes against Vacuum-Assisted Closure Device In diabetic and non-traumatic cellulites of lower limbs
Authors: D.Srinivasan, P.N.Sreeramulu, Naveed Khan, N, M.D.S.Paul Dhinakaran, Dr V.Prajeeth.P Reddy
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.32
Abstract
Fasciotomy done on patient with cellulites can be major contributors not only due to the long stay but also difficult reconstructive surgical challenges. In order to avoid later complications the incised wound once relieved of its compartment pressure should be closed as early as possible to decrease the morbidity and late rehabilitation
Using single incisions either on the medial or lateral side of leg thence opening the compartment of the lateral, superficial posterior, or medial, and deep posterior in a single incision by going through the facial compartment is as good as using multiple incisions on cellulites of lower limbs. Skin grafting often leads to the morbidity and scarring of the donors as well as on the wound site. Hence primary closure of the wound gives as aesthetic and more functional out come with less morbidity for the patients. But can be difficult to achieve secondary to oedema, skin retraction and skin edge necrosis. Our objectives are comparison over using single to double incision used to relieve the compartment pressure secondly time to definite closure and finally traditionally wet to dry dressings and vacuum assisted closure device [VAC]
Materials & Methods: our studies we have selected 84 patients with acute non traumatic cellulites of lower limbs various kinds were included at R.L. Jalappa Hospital & Research Centre, Sri Devaraj Urs Medical College, were randomly assigned into three groups, the study group consisting of 28patients who were trea-ted with vacuum assisted dressing[ Group [A], and 28 patient with both wet assisted cum vacuum dressing [GroupB] and 28 patients into control group who were treated with conventional dressing [Group C] after initial debridement the study group was treated with VAC therapy where a negative pressure of 125 mm
Results: In relation to Sex:-Group A males constituted 64.1% females:-35.9%,in Group B 46%and 28 % and in Group C 49% to 35% respectively. Mean age in Group A.B. and C .Mean ± SD , 84.39 ± 12.29, 84.29+_11.24 , 84.50 ± 11.73 ± SD respectively [Samples are age matched with P=0.609] Mode of onset of cellulites in three groups studied 1]spontaneous ,in A, B,C,GROUPS 42.% . 35.7% 11% 35.7% and traumatic were. 32.1%.28.5%,25.0% respectively.[ P=0.584, Not significant]Associated co-morbidities .in A, ,B,C GROUPS nil .in all groups and diabetics constitutes 32.1%, 28.5%and 25% respectively [P=0.554, Not significant]. Involvement of right leg, 60.7%,50%,42.9%and left leg.39.3%,50%and 57%, respectively [P=0.554, Not significant], Discharge in three groups studied a]Purulent,=92.9,%82.1%,78.6% b]Serous =7.1%,17.9,21.4% respectively [P=0.127, Not significant] Mode of closure in all groups, above1] knee amputations. A,B, were nil, and in group C=1,[p=.000] 2]Epithelisation, A. Group= 7.1% B= 25% C=17..8%[p=003],3] Flap cover in A=3.6% in B&C=nil[P=0.005] 4]. secondary suturing:- in A=46.4%, B=14%& in C=7.1%{p=.000.034} 5].S.S.G:- Group A=42.8% in B= 60.8%.in C=71.4[p=0.039] .Time to heal in days in group A. B and C, Mean ± SD=27.89 ± 12.49, 30.11 ± 14.87 and 39.11 ± 18.87[ p= Mean time to heal in days is significantly less in Vacuum with P=0.001] Duration of stay in the hospital Mean ± SD in Group A= 23.14 ± 10.55 in. B=25.12+_11.00 and in group=28.07 ± 11.0 Mean duration of hospital stay in days is significantly less in Vacuum group with p=0.001 .Granulation tissue: An evaluation at day 1 and Before closure in Group A= pink granulation was 85.1% [ p=0.001] in B=50% and in C=42 %
Conclusion: VAC dressing is effective and better than standard methods of wound care It hastens healing process by rendering the free of inflammatory fluid and reduces the bacterial load from the wound by creating sub-atmospheric pressure there by creating an anaerobic environment so all aerobic and facultative aerobic bacterial infections subsides ,accelerates granulation tissue deposition by increases neo angiogenesis re epitheliazation wound remolding when VAC. Dressing done It provides better pain control and resulted in better patient satisfaction. and when using single incision instead of multiple incision in cellulites of lower limb gives more aesthetic closure and easy to apply VAC THERAPY
Key Points
1. Controlled levels of negative pressure value of 125mmHg accelerates debridement there by promotes wound healing.
2. This procedure was adopted for non-traumatic cellulitis patients. Prior to surgical closures, grafting or reconstructing procedures.
3. The vac treatment is marginally higher in cost wise but scores over favourably with other 9,10
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