Discussion:
A well-known phenomenon related to vascular compromise is acute
compartment syndrome. This alarming phenomenon was observed in our case,
similar to previous reports.8 The presence of a
diaphyseal tibial fracture adds to the chances of developing acute
compartment syndrome and makes the management strategies a difficult
decision.9
Different schools of thought have always governed the management of
these fractures. Whether open internal fixation or an external fixator
is performed is determined according to the patient or the peculiar
case. 10 Previous studies have determined that using
an external fixator in road traffic accident-associated tibial fractures
allows soft tissue injury to heal.11 In our study
setting, this principle is used to achieve delayed primary closure of
the fasciotomy wound secondary to acute compartment syndrome.
The fasciotomy wound can be managed with a wide range of choices;
however, the most effective method to achieve fasciotomy wound closure
is still a debatable topic.4
Popular choices for closing fasciotomy wounds include split-thickness
skin grafts, vacuum suction dressings, and dermo traction using various
types of equipment.12 The principle of dermo traction
is the basis for the pasha device used in this setting.
Additionally, the delayed closure of wounds with tibial fractures is
preferred over primary closure, primarily due to increased complications
confirmed in studies associated with the primary closure of the
fasciotomy wound.13
In light of the studies discussed above, an approach to delayed primary
wound closure using the dermo traction principle was elected. The novel
Pasha device offers this, which uses dermo traction principles with
simple Illizarov device components of wires and threaded bare along with
proline-1 sutures to achieve the necessary
regeneration.7
Our study favors using a pasha device for cases where a fasciotomy wound
converts a closed tibial diaphyseal fracture into an open fracture. It
also provides evidence regarding the efficacy of this method in patients
with a compromised distal neurovascular bundle. Due to posterior tibial
artery transection, delayed wound closure allows the compromised muscle
to form alternate communicating arteries through angiogenesis while the
primary vessel (the posterior tibial artery) is damaged.