Vessel Loop Closure
for cases with excessive swelling
(first posted Octoberr 31, 2007 Last updated November 2, 2007)
The Vessel Loop Closure technique is important to know if faced with a case with exessive swelling, and obviates the need for either free flaps or skin grafts in many cases. The basic concept is that, prior to the injury, the skin was adequate to cover the tissues. Therefore, if there is no skin loss and skin shrinkage can be prevented, once the swelling resolves, the skin can again cover the tissues. The utility of the technique partly is due to the fact that all of the necessary materials are already available in the OR. Although there are commercial adaptations of this technique available, this approach is less expensive and always quickly available.
There are cases where the wound needs to be left open due to contamination, or where the underlying tissues swell extensively and the skin cannot be closed. While the skin is left open, it will retract/contract, and seem to be inadequate for closure. If normal skin tension can be maintained during the time the skin is left open, the skin will not retract/contract, there will be no skin deficit, and a direct closure can be accomplished.
A young man was involved in a high speed motorcycle crash and suffered a distal radius fracture with severe swelling. The radius was fixed with a volar plate, the carpal tunnel was opened, and a forearm fasciotomy was performed. The skin was quite tight and a normal closure is not possible, so a Vessel Loop Closure was performed.