경추의 굴곡-신전 손상으로 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 봉합 = The Use of Vessel Loop Shoelace Technique for Closure of Wound Dehiscence Caused by Dural Tears Associated with Distractive Flexion Injury of Cervical Spine

다국어 초록 (Multilingual Abstract)

Study Design: A case report.
Objectives: To report the use of the shoelace technique for treatment of wound dehiscence caused by dural tears.
Summary of Literature Review: It is difficult to treat wound dehiscence caused by dural tears, as it can lead to infection, loss of soft tissue, and need for a long hospital stay.
Materials and Methods: An 18-year-old male who had been injured in a traffic accident was diagnosed with bilateral facet dislocation of C7-T1, with no neurologic deficit. Clear secretion appeared during the operation, but it disappeared after posterior fusion. The wound began to open about 3 weeks after the operation. We used the vessel loop shoelace technique to suture the wound, Results: The patient had the stitches taken out in the outpatient clinic three weeks after suture. His wounds are healing without complication.
Conclusion: The vessel loop shoelace technique may be a useful treatment for wound dehiscence caused by dural tears.

국문 초록 (Abstract)

연구 계획: 증례 보고적: 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 치료에 대한 경험을 보고하고자 한다.
선행 문헌의 요약: 경막 파열 후 발생하는 창상의 벌어짐은 창상 감염 및 연부 조직의 소실, 장기간의 입원 치료 등을 유발할 수 있어 치료하기 어렵다.
대상 및 방법: 교통사고로 신경학적 결손이 없는 경추 7번과 흉추 1번의 양측성 관절 돌기의 탈구가 발생한 18세 남자환자에 대해 후방 고정술을 시행하였다. 수술 중 뇌척수액으로 추정되는 맑은 분비물이 있었으며 후방 고정술을 시행 후 분비물은 없었다. 수술 3주 후 창상의 벌어짐이 발생하였고 이에 혈관 루프(vessel loop)를 이용한 Shoelace 기법으로 봉합을 시행하였다.
결과: 3주 후 외래에서 혈관 루프를 제거 하였으며 합병증 없이 창상 봉합이 되었다.
결론: 혈관 루프를 이용한 Shoelace 기법은 경막 파열 후 발생하는 창상 벌어짐에 대해 매우 유용한 치료 방법 중 하나라고 생각한다.

참고문헌 (Reference)

1 Luszczyk MJ, "Traumatic dural tears: what do we know and are they a problem?" 14 : 49-56, 2014

2 Asgari MM, "The vessel loop shoelace technique for closure of fasciotomy wounds" 44 : 225-229, 2000

3 Eid A, "Shoelace wound closure for the management of fracture-related fasciotomy wounds" 2012 : 528382-, 2012

4 Mahindra P, "Shoe lace suture technique for management of lower limb diabetic amputationsa study of 24 cases" 7 : 31-33, 2011

5 Khan MH, "Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases" 31 : 2609-2613, 2006

6 Cammisa FP, Jr, "Incidental durotomy in spine surgery" 25 : 2663-2667, 2000

7 Wang JC, "Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients" 80 : 1728-1732, 1998

8 Hannallah D, "Cerebrospinal fluid leaks following cervical spine surgery" 90 : 1101-1105, 2008

9 Fountas KN, "Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report" 30 : E277-E280, 2005

10 Fowler JR, "Assisted closure of fasciotomy wounds: A descriptive series and caution in patients with vascular injury" 1 : 31-35, 2012