Early results using a dynamic method for delayed primary closure of fasciotomy wounds.

Fasciotomy incisions, which are usually performed for compartment syndrome, cannot be closed primarily because of excessive tension across the wound secondary to postischemic swelling of the extremity. Split-thickness skin grafting, the conventional method of fasciotomy closure, is effective but it results in an insensate and cosmetically unappealing wound and is associated with donor site morbidity. Skin has several unique and useful properties that allow for delayed primary closure of wounds despite large tissue defects or significant retraction. These biomechanical properties, which include inherent extensibility and mechanical and biological creep, have been exploited by a variety of techniques for delayed primary closure of fasciotomy wounds. The vessel loop shoelace technique, use of the Sure-Closure skin-stretching device (Comesa), use of a prepositioned cutaneous suture, and several other techniques have shown reasonable wound closure rates and wound cosmesis, but have been criticized because they are expensive, cumbersome to apply and to tighten, or are associated with increased compartment pressures and skin edge necrosis. The following case series presents our results using a new method of dynamic wound closure with a novel device (Canica Design, Inc) applied to six fasciotomy incisions.