Contents lists available at ScienceDirect Trauma Case Reports journal homepage: www.elsevier.com/locate/tcr Case Report Surgical management of compartment syndrome and the gradual closure of a fasciotomy wound using a DermaClose device Gregory C. Manista ⁎ , Andrew Dennis, Matthew Kaminsky Cook County Trauma Unit, John H. Stroger, Jr. Hospital, Chicago Illinois, United States ARTICLE INFO Keywords: Compartment syndrome Fasciotomy DermaClose device Wound closure ABSTRACT The immediate recognition and timely response of compartment syndrome due to damage caused by penetrating trauma has immense clinical outcomes. The following is a case report of a com- plicated fasciotomy in a 33-year-old male who suffered a gunshot wound to his left lower ex- tremity and the surgical management leading to adequate limb salvage and recovery. The unpredictability of damage caused by gunshot wounds (GSW) requires precise emergent decisions from the attending surgical staff in order to prevent further life threatening complications. The following is a case report of a complicated fasciotomy in a 33- year-old male who suffered a GSW to his left lower extremity (LLE). The patient was transferred to the Cook County Trauma Unit after initially presenting to an outside hospital. The patient's condition was stabilized with 2 L of normal saline and 2 units of O-blood due to significant bleeding. X-rays of the left lower extremity revealed a retained missile in the left anterior lower leg. Although hemodynamically stable, the patient developed pain with passive flexion and paresthesia in the left lateral foot. Given the clinical findings, the decision was made to take the patient to the operating room due to developing signs of compartment syndrome with sensory loss. The patient was taken to the operating room for a four-compartment fasciotomy of the left lower extremity. After a satisfactory release of bulging muscle was achieved, it became evident that large volume bleeding continued from the site of the GSW. Injury to the posterior tibial (PT) trunk in addition to multiple regional veins was noted. The PT trunk, peroneal vein and PT vein appeared to have been ligated from the trajectory of the missile. The vessels were appropriately identified and viable re-attachment allowed for a palpable deep peroneal (DP) pulse, with ligation of the PT trunk leaving no PT signal or pulses at completion of the case. During post op day one, the open LLE had continued to have a deep active bleeding space in the medial fasciotomy wound site (Fig. 1). The patient was taken to the operating room for wound exploration (Figs. 1 and 2). During the procedure, ligation of multiple venous collateral vessels was achieved allowing for appropriate hemostasis and cessation of the oozing muscle belly, which was occurring from the macerated muscle. Celox and Kerlix were then used to achieve further hemostasis, and the patient was taken to the trauma ICU in stable condition. Over the course leading up to post op day 7, the oozing muscle belly was well controlled and the open LLE was viable for closure. The patient was taken to the OR where a primary skin closure of the lateral wound was performed (Fig. 3) and two DermaClose devices [DermaClose, Chanhassen, MN, USA] were positioned over the medial wound site due to the large wound size (Fig. 4). Proper attachment of the device was achieved and the patient tolerated the procedure well and was taken to the recovery floor. Over the course of the next week, the stable auto-ratcheting tension from the DermaClose devices approximated the skin edges to a distance where the skin fasciotomy sites could be closed with minimal undermining and tension. The final closure operation occurred 8 days following the application of the DermaClose system (Fig. 5). The skin edges were https://doi.org/10.1016/j.tcr.2017.10.003 Accepted 16 October 2017 ⁎ Corresponding author at: Cook County Trauma and Burn Unit, John H. Stroger, Jr. Hospital, 1900 W. Polk St., Chicago, IL 60612, United States. E-mail address: gregory_manista@rush.edu (G.C. Manista). Trauma Case Reports 14 (2018) 1–4 Available online 01 February 2018 2352-6440/ © 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).