History and Examination:
A 27-year-old male landed in the trauma center of a tertiary health care facility in Punjab, Pakistan. The patient was in a road traffic accident and had a closed fracture of the Tibia. The patient had a compromised distal neurovascular bundle. Considering this scenario, the intercompartment pressure of his leg was measured, which was more than 30 mmHg. An urgent fasciotomy was performed, and upon exploration, transection of the posterior tibial artery was observed. The transacted artery was repaired by a general surgeon, followed by an external fixator application for tibia fixation. The fasciotomy wound is shown in figure 1.
A new instrument, the Pasha Device, was used to help close a fasciotomy wound. Grounded in the fundamentals of the Illizarov traction regeneration technique, this device utilizes key components typical of those employed with these tools and methodologies, which are frequently used within orthopedic surgery for both bone and soft tissue traction and regeneration.
The approach started with extensive debridement of the wound to eliminate necrotic tissue and microorganisms, guaranteeing a clean and fresh surgical field. After preparing the wound, two special wires were carefully passed through various subcutaneous planes (layers of tissues lying just above the deep fascia). These wires were positioned to allow for the effective distribution of adhesive tractive stresses.
The suture pulley provided by the Pasha device made from Prolene 0-1 was applied. These sutures were placed to work with the device in performing controlled dermo traction. This machine was like a dermo tractor since it pulled the skin and deeper tissues continuously, thus progressively pulling together the wound ends.
Figures 2, 3, and 4 show that the two threaded bars of the Pasha Device were rigidly fixed along the wound edges. The fixing provided the support necessary for an even distribution of traction forces, thus helping to close the fasciotomy wound successfully. Thus, mechanical traction by the Pasha Device combined with a precise suturing technique resulted in effective wound closure with low tension and good healing conditions.
Over 20 days, the device’s wires were tightened, and the edges were brought closer based on the principle of dermo traction, resulting in the complete closure of the wound during this period. This can be seen in figures 5, 6 and 7.
The wound healed entirely over 35 days (figures 8, 9 and 10). The external fixator remains in place and is scheduled for removal around the 75th day. The patient is showing excellent recovery, with significant improvement in mobility. He is now able to bear weight on the affected limb and is expected to return to complete mobility after the removal of the external fixator.