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.