title: The use of an innovative device for wound closure after upper extremity fasciotomy.
abstract: BACKGROUND
  The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds.
  
  
  METHODS
  A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG).
  
  
  RESULTS
  Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days).
  
  
  CONCLUSIONS
  We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a second-stage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.
authors.affiliation: Department of Surgery, Temple University Hospital, Zone C, Fourth Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA. cmedina@temple.edu
authors.forename: Carlos
authors.initials: C
authors.lastname: Medina
authors.forename: Julia
authors.initials: J
authors.lastname: Spears
authors.forename: Amitabha
authors.initials: A
authors.lastname: Mitra
references.citation: Ann Plast Surg. 2000 Feb;44(2):225-9
references.pmid: 10696053
references.citation: Ann Chir Plast Esthet. 1996 Oct;41(5):577-81
references.pmid: 9687613
references.citation: Am J Surg. 1980 Dec;140(6):825-31
references.pmid: 7457708
references.citation: Surg Clin North Am. 1983 Jun;63(3):539-65
references.pmid: 6346542
references.citation: Orthop Rev. 1991 Jan;20(1):82, 84
references.pmid: 1997958
references.citation: Arch Surg. 1970 Dec;101(6):663-72
references.pmid: 5489289
references.citation: Orthopedics. 1986 Sep;9(9):1243-6
references.pmid: 3763495
references.citation: Surg Gynecol Obstet. 1978 Dec;147(6):943-9
references.pmid: 362581
references.citation: Am J Surg. 2000 Jul;180(1):55-7
references.pmid: 11036142
references.citation: J Burn Care Rehabil. 1997 Mar-Apr;18(2):125-32
references.pmid: 9095421
references.citation: Plast Reconstr Surg. 1993 Aug;92(2):260-70
references.pmid: 8337276
references.citation: Am J Surg. 1992 Sep;164(3):286-90
references.pmid: 1415931
references.citation: Scand J Plast Reconstr Surg Hand Surg. 1993 Sep;27(3):179-82
references.pmid: 8272768
references.citation: Ann Plast Surg. 1995 Nov;35(5):485-91
references.pmid: 8579266
references.citation: J Trauma. 1971 Sep;11(9):763-70
references.pmid: 5094746