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

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 regeneration technique. Study Design: Descriptive study. Place and Duration of Study: This study was conducted 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 fixation device was designed and manufactured from components 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 reliable and will decrease the need for skin grafting for coverage of such wounds. The review of the international literature shows that the “Pasha Device” and technique of its application to close fasciotomy wounds is addition of new knowledge and technology infield of treatment of such defects