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Abstract
Fasciotomy for compartment syndrome in the lower limb is a surgical emergency to preserve
future limb function. The advised standard procedure involves both medial and lateral
dermotomy in addition to the fasciotomy. There is often concern before and after performing
fasciotomy about the cosmetic appearance and prolonged hospital stay if split skin
grafting is required to cover the resultant skin defect. This is the case in over
50% of lower limb fasciotomies. We have used a technique of subcuticular prolene suture,
first described for the delayed primary closure of contaminated abdominal wounds,
in six patients who had undergone lower limb fasciotomies. In all of these cases delayed
primary closure was easily achieved without the need for skin grafting. Experiments
using a synthetic skin model have shown a 60% reduction in suture tension when compared
with interrupted vertical mattress suturing. The subcutaneous prolene suture has the
advantage of being both the method of approximation and final closure whilst spreading
tension evenly across the wound edges without causing skin edge necrosis. It appears
to be simpler and more economical than any technique so far described for the successful
delayed primary closure of fasciotomy wounds.