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.