Surgical applications of intact and fragmented fish skin grafts and NPWT for lower extremity wounds secondary to multiple fasciotomies for acute compartment syndrome: Case Report

Introduction: Fasciotomy is the definitive treatment for acute compartment syndrome to decompress the involved compartments, decreasing the risk of amputation of the affected limbs. Although this is a life-saving procedure, patients are often faced with complications including long hospital stays, wound infection, and osteomyelitis due to the challenges associated with healing these full-thickness wounds. With no clear consensus regarding the best methodology for closure of fasciotomy wounds, the technique applied each time is largely the surgeon’s preference. In this case report, the feasibility of a fish skin graft for definitive fasciotomy wound closure in a single patient with multiple wounds is assessed.

Methods: A 16-year-old male patient presents with acute onset compartment syndrome of the distal right leg and secondary rhabdomyolysis a week after hallux valgus repair and 1st tarsometatarsal joint arthrodesis. The patient received multiple fasciotomies of the right leg, resulting in a total of five wounds. The wound beds were debrided three days after the procedure and meshed fish skin grafts were sutured in place followed by non-adherent dressing before continuous negative pressure wound therapy (NPWT) at 125 mmHg setting with bridging between wound sites.

Results: Complete wound closure was achieved for all five wounds within 3 months post fasciotomy procedure. The patient received four applications of fish skin graft to all sites, including a single application of fragmented intact fish skin graft into the larger area wounds. The patient received weekly wound debridement and application of NPWT three times weekly.

Discussion: Most wound sites were epithelialized within two months. The average wound surface area reduction across the five wounds one month after the application of fish skin was over 7%. The wounds showed an earlier buildup of granulation tissue. The results had good cosmetic and functional outcomes for the patient.