Skin traction is used where a smaller amount of force is required to correct the deformity. If not used carefully complications of skin traction may occur which include following.
Complications of skin traction mostly involve skin. The skin is easily traumatized by this method and can cause various degrees of injury, from abrasion to partial-thickness skin loss.
If the elastic bandages are wrapped too tightly or unevenly, it may result in circulatory impairment and may lead to development of pressure area. This is especially true for bony and soft tissue prominences.
Circumferential wrappings around an extremity can cause trauma to nerves that are superficial, especially the peroneal nerve below-the-knee and the ulnar nerve at the elbow. Pain, paresthesia, and loss of function are signs of excessive pressure on nerves.
Compartment syndrome is one of the severe complications of skin traction and may be defined as a deprivation of blood supply to a group of muscles due to raised pressure within the compartment which is severe enough to occlude the arterial capillaries. This results in anoxia or absence of oxygen. Muscles react to anoxia by swelling, which further compromises the blood supply. If these conditions are not reversed, muscle death occurs.
The causes may be direct injury to the soft tissues, injury to the vascular supply, or external compressing forces. In most cases, it appears to result from a combination of these factors.
Traction applied with skin attachments may not provide the desired degree of immobilization.
Prevention and Treatment of Complications of Skin Traction
- Skin trauma can be avoided by careful inspection. A rash, abrasion, or open wound is a contra¬indication to skin attachment.
- The skin must be cleansed thoroughly with soap and water before the straps are applied.
- The elastic bandages must be wrapped evenly with gentle, equal pressure exerted with every turn around the extremity. The bandages should be removed and rewrapped daily and adjusted frequently.
During the daily adjustments, the skin should be reinspected for signs of skin breakdown.
- Areas of bony or soft tissue prominences should be elevated or padded. Special attention should be paid to these areas during the daily skin inspection.
- No more than 5 kg of weight should be applied to a skin attachment setup, and the period in traction should be no more than 3 months.
- Bony prominences, such as the head of the fibula and the olecranon, must be well padded. Daily monitoring of motor and sensory function in the extremity is essential.
- If removal of the elastic bandage does not relieve the compartment syndrome, fasciotomy may be indicated to cut the fascia of muscle compartments.
- Frequent inspection and adjustment of the set up may prevent mechanical failure. Lateral rotation can be prevented by the use of pillows or padded sandbags to maintain the extremity in neutral position
- Patients who are disoriented or young children who will not keep still must be considered candidates for other forms of immobilization
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