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Li G, Huang Y, Song M, Lu M. What are optimum cycles for immediate primary closure of large cutaneous defects? Sci Prog 2024; 107:368504231223037. [PMID: 38439712 PMCID: PMC10916480 DOI: 10.1177/00368504231223037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND In the reconstruction of large complex cutaneous wounds, a myriad of mechanical devices has been designed to facilitate primary wound closure. However, there is a dearth of studies elucidating how best to achieve optimum use and efficiency of skin stretching (SS) when using the device for immediate primary closure of defects. METHODS Skin defect wounds (7 × 7 cm) were prepared on the back of three Bama miniature pigs. A total of 15 cycles of SS (cycle loading) were subsequently performed on the skin edges of the wound by EASApprox® SS system. Then, the changes in equidistant points were recorded after each cycle. After the SS test, all wounds were sutured under low tension. RESULTS Skin elongation was observed at all equidistant points on the back wounds of three Bama miniature pigs. Up to an additional 1.10 to 3.75 cm of tissue was garnered. The maximum skin elongation was typically achieved within eight cycles of stretching and relaxation. Beyond this range, additional stretching cycles did not result in further skin extension. CONCLUSION There may be a close link between mobilization range and the times of acute cyclic stretching (cycle loading) during the process of primary wound closure. However, larger studies are required to further evaluate the accuracy and effectiveness.
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Affiliation(s)
- Gang Li
- Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
- Department of Orthopaedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Yajun Huang
- Department of Plastic Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Ming Lu
- Department of Orthopaedics, Dalian Municipal Central Hospital, Dalian, People's Republic of China
- State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, Dalian University of Technology, Dalian, People's Republic of China
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Kumar A, Kumar N, Jha MK. Role of Preoperative Skin Stretching in Single-Stage Wound Closure. Indian J Plast Surg 2022; 55:287-293. [PMID: 36325093 PMCID: PMC9622329 DOI: 10.1055/s-0042-1756131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Mechanical skin stretching (SS) is now becoming one of the commonly sought after procedures for wound healing. This study was aimed to assess the efficacy of preoperative SS for the closure of large wounds and to evaluate various postoperative outcome parameters. Methodology An observational study was conducted from December 2017 to May 2019 where a sample size of 30 patients was included with inclusion criteria being wounds of ≥5 cm width that require surgical management, presence of sufficient healthy skin edge of the wound/scar (at least one) for the stretching procedure, and age between 18 and 70 years. SS devices used were the top closure tension relief system. Postoperatively, various parameters were recorded to evaluate outcomes and complications. Results Majority of wounds that is 16 (53.3%) were <50 cm 2 , 9 (30%) were between 50 and 75 cm 2 , and 5 (16.7%) were >75 cm 2 . The mean duration of stretch was 2.3 ± 0.82 weeks. For 30 wounds treated with staged cycles of wound closure, there was a significant difference between every two visit points, i.e., 10%. The mean patient-reported patient and observer scar assessment scale score was 3.5 ± 0.93. Twenty-five cases (83.3%) had uneventful postoperative recovery. Twenty-seven patients (90%) reported an improved aesthetic outcome. Fourteen patients (46.7%) reported some improvement in function. Conclusion The study concluded that the SS devices are the simple and effective method for the primary closure of large and challenging wounds and skin defects.
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Affiliation(s)
- Anchit Kumar
- Centre for Plastic Cosmetic Surgery, BLK Superspeciality Hospital, New Delhi, India
| | - Naveen Kumar
- Department of Plastic Surgery, Lady Hardinge Medical College and Associated Hospital, New Delhi, India,Address for correspondence Naveen Kumar, MS, MCh Department of Plastic Surgery, Lady Hardinge Medical College and Associated HospitalNew Delhi 110001India
| | - Manoj K. Jha
- Department of Burns, Plastic and Reconstructive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Wang X, Zhang Y, Ng SKH, Zhang Z, Pu Z, Yang H, Min P. Using Modified Skin-Stretching Technique as an Alternative Solution for the Closure of Moderate and Extensive Skin Defects. Rejuvenation Res 2021; 24:407-416. [PMID: 34714135 DOI: 10.1089/rej.2020.2389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
External skin-stretching devices have been developed and used for wound closure since 1970s. Devices such as Miami STAR®, SureClosure®, TopClosure®, and WiseBand® have their own advantages and disadvantages. The modified external skin-stretching technique of this case series study has the advantage to improve tension distribution and simplified the application. Between January 2014 and June 2017, 20 patients were treated with the modified external skin-stretching device for the closure of the skin defects of the trunk (n = 6) and extremities (n = 14). Skin defects ranged from 8 × 5 to 19 × 16 cm achieved primary closure with the utilization of the modified skin-stretching device without major complications. Subsequent minor revisions were performed under local anesthesia between 6 and 12 months postoperatively. The modified skin-stretching device utilized biomechanical properties and mechanical creep of skin tissue to achieve a reliable and effective primary closure for moderate to extensive skin defects. Therefore, this modified external skin-stretching technique provided, in the appropriate setting, an effective alternative to skin grafts or free flaps.
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Affiliation(s)
- Xin Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Sally Kiu-Huen Ng
- Department of Plastic Surgery, Austin Hospital, Melbourne, Australia
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - ZheMing Pu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - PeiRu Min
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Daya M, Aldous C. Acute tissue expansion by pretaping to achieve elliptical excision and closure for skin tumours and soft tissue tumours. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang X, Zhu Z, Zhao Y, Yu M, Topaz M. The effect of TopClosure® TRS in the treatment of large abdominal wall defect. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Primary Closure of Wide Fasciotomy and Surgical Wounds Using Rubber Band-Assisted External Tissue Expansion: A Simple, Safe, and Cost-effective Technique. Ann Plast Surg 2019; 81:344-352. [PMID: 29905602 DOI: 10.1097/sap.0000000000001506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although decompressive fasciotomy is a limb-saving procedure in the setting of acute compartment syndrome, it leaves a large wound defect with tissue edema and skin retraction that can preclude primary closure. Numerous techniques have been described to address the challenge of closing fasciotomy wounds. This study reports our experience with fasciotomy closure using rubber bands (RBs) for external tissue expansion. METHODS Patients were informed about RB closure and split-thickness skin graft options. Only patients who opted for RB closure and had wounds that could not be approximated using the pinch test underwent the procedure. Starting from the apex and progressively advancing, the RBs were applied to the skin edges at 3 to 4 mm intervals using staples. The RBs were advanced by twisting back-and-forth to create a criss-cross pattern. One week after application, fasciotomy wounds were closed primarily or underwent further RB application, based on clinical assessment of adequacy of skin advancement, compartment tension, and perfusion. Review of a prospectively maintained database was performed, including demographics, comorbidities, etiology, wound and operative details, hospital stay, and complications. RESULTS Seventeen consecutive patients with 25 wounds (22 fasciotomy and 3 other surgical wounds) were treated using the RB technique. Average wound length and width measured 15.7 cm (range, 5-32 cm) and 5.2 cm (range, 1-12 cm), respectively. Locations of wounds included forearm (n = 12, 48.0%), leg (n = 7, 28.0%), hand (n = 4, 16.0%), elbow (n = 1, 4.0%), and hip (n = 1, 4.0%). Eighteen of 25 wounds (72.0%) were closed primarily after 1 RB application. Additional RB application was required for 5 wounds to achieve primary closure. Between stages, patients were discharged home if they did not have other conditions requiring in-hospital stay. No complications were observed, and no revision surgeries were required. Patient satisfaction was 100%, and all indicated that they would choose the RB technique over skin grafting. CONCLUSIONS The modified RB technique is a simple, safe, and cost-effective alternative for treating fasciotomy and other surgical defects resulting in high patient satisfaction and good cosmetic outcome, without the need for split-thickness skin graft or flap coverage.
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Closure of a full-thickness scalp burn that occurred during hair coloring using a simple skin-stretching method: A case report and review of the literature. Arch Plast Surg 2019; 46:167-170. [PMID: 30934182 PMCID: PMC6446037 DOI: 10.5999/aps.2018.00871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were 10 cm×5 cm, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.
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Pu S, Lü Q, Zhao Z, Hu D, Chen X, Chen H, Zhu Y, Xu Y. [Application of self-made chronic wound closure device in the repair of scarred lower extremity wounds]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:219-222. [PMID: 30739419 PMCID: PMC8337603 DOI: 10.7507/1002-1892.201803045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/02/2019] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of self-made limb chronic wound closure device in the treatment of scarred lower limbs and complex skin and soft tissue defects. Methods Between January 2014 and January 2017, 29 patients with complex fractures of the lower extremities and skin and soft tissue defects were treated. There were 19 males and 10 females with an average age of 31.1 years (range, 21-66 years). The causes of injury included 14 cases of traffic accidents, 5 cases of falling from height, 4 cases of heavy object crushing injury, 4 cases of mechanical crushing injury, and 2 cases of exposed steel plate after fracture. There were 26 cases of calf fracture and skin defect, 3 cases of metatarsal bone fracture and skin defect of the foot. The skin defect ranged from 5 cm×3 cm to 18 cm×8 cm. The time from injury to admission was 5-31 days, with an average of 14.3 days. All patients underwent a thorough debridement, open wound drainage, self-made chronic wound closure device combined with Ilizarov stretching technique for a slow skin and soft tissue traction. After the wound was cleaned up and the granulation tissue was freshened, the skins on both sides were closed, and then proceed to the second stage operation of skin grafting or direct suture closure based on the size of the wound. Results All patients were followed up 8-20 months, with an average of 13 months. Twenty-nine patients were treated with self-made chronic wound closure device combined with Ilizarov technique for 1-2 times with an average of 1.3 times, then the wound infection was controlled and the granulation tissue grew well. In the course of treatment, the pain was not obvious and the patients had good compliance. All patients' wounds healed clinically without skin traction complications and formed linear or flaky scars. Conclusion The self-made chronic wound closure device is effective in repairing complex scarred wounds of lower extremities, and it is easy to operate.
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Affiliation(s)
- Shaoquan Pu
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Qian Lü
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Zeyu Zhao
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Dan Hu
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xiang Chen
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Hanfen Chen
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Yueliang Zhu
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032,
| | - Yongqing Xu
- Department of orthopedics, the Joint Service Support Force 920 th Hospital of Chinese PLA, Kunming Yunnan, 650032, P.R.China
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Dong Q, Gu G, Wang L, Fu K, Xie S, Zhang S, Zhang H, Wu Z. [Application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 31:1481-1484. [PMID: 29806391 DOI: 10.7507/1002-1892.201707103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect. Methods Between March 2016 and April 2017, 21 cases of skin and soft tissue defects were repaired with the modified adjustable skin stretching and secure wound-closure system (the size of regulating pressure and the times of adjustment were determined according to the color, temperature, capillary response, and swelling degree of the skin edge). There were 11 males and 10 females, with an average age of 49.2 years (range, 21-67 years). Among them, 1 case was the residual wound after amputation of leg; 18 cases were the wounds after traumatic injury operation, including 4 cases in the lower leg, 3 cases in the knee joint, 7 cases in the upper limb, and 4 cases in the foot; and 2 cases were diabetic feet. The skin defect area ranged from 4.0 cm×2.5 cm to 21.0 cm×10.0 cm. Results Skin defect wounds closed directly in one stage in 4 cases; 12 cases were closed after continuously stretching for 5-14 days (mean, 10 days); 5 cases were reduced to less than one-half area, and the wound healed after the second skin grafting or flap repairing. All the 21 patients were followed up 3-12 months (mean, 5.2 months). The wound was linear healing with small scar, and no invasive margin, poor blood flow, necrosis, and poor sensory function happened. Conclusion The modified adjustable skin stretching and secure wound-closure system can reduce the skin and soft tissue defects or close the wound directly, and even replace the skin graft and skin flap repairing. It was a good method for the treatment of skin and soft tissue defect.
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Affiliation(s)
- Qiqiang Dong
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Guojun Gu
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Lijun Wang
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Keda Fu
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000,
| | - Shuqiang Xie
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Songjian Zhang
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Huafeng Zhang
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
| | - Zhaosen Wu
- The Third Department of Surgery, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China
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Song M, Zhang Z, Liu T, Liu S, Li G, Liu Z, Huang J, Chen S, Li L, Guo L, Qiu Y, Wan J, Liu Y, Wu T, Wang X, Lu M, Wang S. EASApprox ® skin-stretching system: A secure and effective method to achieve wound closure. Exp Ther Med 2017; 14:531-538. [PMID: 28672963 PMCID: PMC5488469 DOI: 10.3892/etm.2017.4539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/06/2017] [Indexed: 02/02/2023] Open
Abstract
Large skin defects are commonly observed in the clinic and have attracted much attention recently. Therefore, finding an effective solution for large skin defects is a global problem. The objective of the present study was to assess the effectiveness of the EASApprox® skin-stretching system for closing large skin defects. Skin defects (5×5 cm) were created on the forearms of 9 Bama miniature pigs, which were randomly divided into the following three groups: Direct suture, the new EASApprox® skin-stretching device and Kirschner wires. Microcirculation was assessed before surgery and after wound closure. Following the different treatments, the defects were sutured, and wound healing was assessed based on a clinical score. Furthermore, microscopic and ultramicroscopic structures were evaluated, including collagen, elastic fibers and the microvessel density. Significant differences in the clinical score and microvessel density were observed among the groups. Additionally, the mean length obtained for elastic fibers was larger than that obtained for the other two groups. Finally, the new EASApprox® skin-stretching device resulted in successful wound management and with only minor side effects on skin histology and microcirculation. Therefore, this method has the potential to be used for healing large skin defects.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Department of Orthopedics, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning 116200, P.R. China
| | - Zhen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Tao Liu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Song Liu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Gang Li
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Zhaochang Liu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jingyang Huang
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Song Chen
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Linan Li
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Li Guo
- Central Research Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Yang Qiu
- Central Research Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jiajia Wan
- Central Research Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Yuejian Liu
- Central Research Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Tao Wu
- Department of Anesthesia, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Xiaoyong Wang
- BIOWIM (China), Ltd., Economic & Technological Development Zone, Dalian, Liaoning 116620, P.R. China
| | - Ming Lu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Shouyu Wang
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
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Abstract
The aim of this study was to compare the skin tension of several fascial/subcutaneous tensile reduction sutures. Six upper limbs and 8 lower limbs of 4 fresh cadavers were used. At the deltoid area (10 cm below the palpable acromion) and lateral thigh (midpoint from the palpable greater trochanter to the lateral border of the patella), and within a 3 × 6-cm fusiform area of skin, subcutaneous tissue defects were created. At the midpoint of the defect, a no. 5 silk suture was passed through the dermis at a 5-mm margin of the defect, and the defect was approximated. The initial tension to approximate the margins was measured using a tensiometer.The tension needed to approximate skin without any tension reduction suture (S) was 6.5 ± 4.6 N (Newton). The tensions needed to approximate superficial fascia (SF) and deep fascia (DF) were 7.8 ± 3.4 N and 10.3 ± 5.1 N, respectively. The tension needed to approximate the skin after approximating the SF was 4.1 ± 3.4 N. The tension needed to approximate the skin after approximating the DF was 4.9 ± 4.0 N. The tension reduction effect of approximating the SF was 38.8 ± 16.4% (2.4 ± 1.5 N, P = 0.000 [ANOVA, Scheffé]). The tension reduction effect of approximating the DF was 25.2% ± 21.9% (1.5 ± 1.4 N, P = 0.001 [ANOVA, Scheffé]). The reason for this is thought to be that the SF is located closely to the skin unlike the DF. The results of this study might be a basis for tension reduction sutures.
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Abstract
BACKGROUND Linear closure (LC) is the most common reconstructive design for cutaneous defects. Successful performance of a LC is dependent on both appropriate surgical planning and technical execution. OBJECTIVE To review the design and execution of LCs on the face. MATERIALS AND METHODS A systematic evaluation of LCs is provided to guide a logical approach for the repair of cutaneous facial defects. RESULTS Reproducibly excellent aesthetic and functional results may be achieved with strategies that reduce incisional tension, preserve free margin position, and restore skin contour. Cosmetic unit borders and relaxed skin tension lines may be used to further camouflage facial scars. A comprehensive knowledge of facial anatomy, biomechanical properties of the skin, and incisional tension vectors facilitates correct preoperative planning and intraoperative technique. CONCLUSION Proper design and execution of LCs allow for enhanced cosmesis and permit the cutaneous surgeon to progress to more technically advanced surgical procedures such as cutaneous flaps.
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Magalhães MAB, Petroianu A, Martins SGDO, Resende V, Alberti LR, Barbosa AJA, Vasconcellos LDS, Tavares Junior WC. Closure of large wounds using rubber bands in rabbits. Rev Col Bras Cir 2015; 42:56-61. [PMID: 25992702 DOI: 10.1590/0100-69912015001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/15/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8 cm long by 12 cm wide. All animals were observed for 21 days. RESULTS two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.
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Affiliation(s)
| | - Andy Petroianu
- Department of Surgery, Faculty of Medicine, UFMG, Minas Gerais, Brazil
| | | | - Vivian Resende
- Department of Surgery, Faculty of Medicine, UFMG, Minas Gerais, Brazil
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Topaz M, Carmel NN, Topaz G, Li M, Li YZ. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept: new concept for direct closure of large defects. Medicine (Baltimore) 2014; 93:e234. [PMID: 25526444 PMCID: PMC4603089 DOI: 10.1097/md.0000000000000234] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Stress-relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects. The aim of this study was to evaluate the efficiency of the TopClosure TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress-relaxation. We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress-relaxation, and following surgery as skin-secure system until complete wound closure. All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress-relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved. In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress-relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range of applications on a global scale.
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Affiliation(s)
- Moris Topaz
- From the Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel (MT); Department of Chemistry, Bar Ilan University, Ramat Gan, Israel (NNC, GT); Medical Intern, HaSharon Medical Center, Rabin Campus, Petah Tikva, Israel (NNC); Medical Intern, Wolfson Medical Center, Holon, Israel (GT); Department of Plastic Surgery, Second People's Hospital, Taiyuan, China (ML); and Department of Plastic Surgery, Deyang People's Hospital, Deyang, China (YZL)
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Tsioli V, Papazoglou LG, Papaioannou N, Psalla D, Savvas I, Pavlidis L, Karayannopoulpou M. Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs. J Vet Sci 2014; 16:99-106. [PMID: 25269717 PMCID: PMC4367155 DOI: 10.4142/jvs.2015.16.1.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/26/2014] [Indexed: 12/03/2022] Open
Abstract
Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.
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Affiliation(s)
- Vassiliki Tsioli
- Department of Surgery, Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100,
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16
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Al-Benna S. Establishing Tension-Free Direct Wound Closure Using the Viscoelastic Properties of the Skin. J Cutan Med Surg 2014; 18:307-15. [DOI: 10.2310/7750.2013.13137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Establishing tension-free direct wound closure is important for optimal postsurgical wound healing. Direct closure should not be forced by raising wound tension. Objective: The aim of this article is to review the viscoelastic properties of skin and describe tension-relieving techniques to aid optimal wound closure.
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Affiliation(s)
- Sammy Al-Benna
- From the Department of Plastic, Reconstructive and Burns Surgery, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
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17
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Felcht M, Koenen W, Weiss C, Weina K, Geraud C, Faulhaber J. Delayed closure of complex defects with serial tightening of loop sutures - clinical outcome in 64 consecutive patients. J Eur Acad Dermatol Venereol 2013; 28:454-60. [DOI: 10.1111/jdv.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Moritz Felcht
- Department of Dermatology; Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
| | - Wolfgang Koenen
- Department of Dermatology; Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
| | - Kasia Weina
- Department of Dermatology; Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
| | - Cyrill Geraud
- Department of Dermatology; Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
| | - Jörg Faulhaber
- Department of Dermatology; Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karls University Heidelberg; Mannheim Germany
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18
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The TopClosure® 3S System, for skin stretching and a secure wound closure. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012; 35:533-543. [PMID: 22719176 PMCID: PMC3375424 DOI: 10.1007/s00238-011-0671-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 11/17/2011] [Indexed: 12/27/2022]
Abstract
The principle of stretching wound margins for primary wound closure is commonly practiced and used for various skin defects, leading at times to excessive tension and complications during wound closure. Different surgical techniques, skin stretching devices and tissue expanders have been utilized to address this issue. Previously designed skin stretching devices resulted in considerable morbidity. They were invasive by nature and associated with relatively high localized tissue pressure, frequently leading to necrosis, damage and tearing of skin at the wound margins. To assess the clinical effectiveness and performance and, to determine the safety of TopClosure® for gradual, controlled, temporary, noninvasive and invasive applications for skin stretching and secure wound closing, the TopClosure® device was applied to 20 patients for preoperative skin lesion removal and to secure closure of a variety of wound sizes. TopClosure® was reinforced with adhesives, staples and/or surgical sutures, depending on the circumstances of the wound and the surgeon's judgment. TopClosure® was used prior to, during and/or after surgery to reduce tension across wound edges. No significant complications or adverse events were associated with its use. TopClosure® was effectively used for preoperative skin expansion in preparation for dermal resection (e.g., congenital nevi). It aided closure of large wounds involving significant loss of skin and soft tissue by mobilizing skin and subcutaneous tissue, thus avoiding the need for skin grafts or flaps. Following surgery, it was used to secure closure of wounds under tension, thus improving wound aesthetics. A sample case study will be presented. We designed TopClosure®, an innovative device, to modify the currently practiced concept of wound closure by applying minimal stress to the skin, away from damaged wound edges, with flexible force vectors and versatile methods of attachment to the skin, in a noninvasive or invasive manner.
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Verhaegen PD, van der Wal MB, Bloemen MC, Dokter J, Melis P, Middelkoop E, van Zuijlen PP. Sustainable effect of skin stretching for burn scar excision: Long-term results of a multicenter randomized controlled trial. Burns 2011; 37:1222-8. [DOI: 10.1016/j.burns.2011.04.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
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20
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Ibrahim AE, Dibo SA, Hayek SN, Atiyeh BS. Reverse tissue expansion by liposuction deflation for revision of post-surgical thigh scars. Int Wound J 2011; 8:622-31. [PMID: 21895976 DOI: 10.1111/j.1742-481x.2011.00842.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Scars hypertrophy and widen when stretching mechanical forces are applied to resilient newly formed collagen before it reaches final maturity marring the final result of many surgical procedures and resulting in a clinical problem for many patients. Scar revision by surgical excision remains the traditional treatment for hypertrophic or widespread scars. It relies upon recruitment of local tissues for closure of the ensuing defect. Providing tension-free skin closure is the best option to avoid recurrence. Although tissue expansion procedure is a valuable and reliable technique for scar revision, it has its own disadvantages and potential complications. We describe an alternative method for scar revision that may be applicable in certain situations. Instead of expanding the soft tissues to make available additional skin, deflation by liposuction may be affected to relax the skin envelope thus indirectly providing additional skin for scar revision. We call this method 'reverse tissue expansion'.
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Affiliation(s)
- Amir E Ibrahim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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21
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Efficacy of Skin Stretching for Burn Scar Excision: A Multicenter Randomized Controlled Trial. Plast Reconstr Surg 2011; 127:1958-1966. [DOI: 10.1097/prs.0b013e31820cf4be] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen X, Jiang Z, Chen Z, Wang D. Application of skin traction for surgical treatment of grade IV pressure sore: a clinical report of 160 cases. Spinal Cord 2010; 49:76-80. [PMID: 20644559 DOI: 10.1038/sc.2010.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE To assess the method of primary surgical closure of pressure sores developed by the Ruixin Hospital for burns. SETTING Nanjing, China. METHODS The study included 235 grade IV pressure sores of 160 patients, M:F = 119:41. Their age ranged from 19 to 93 years (mean = 47.4, s.d. ± 15.7). The primary disease was spinal cord injury in 141 patients (88.1%). The location of sore spread over ischial, sacrococcygeal and trochanteric regions. The largest pressure sore measured 15 × 25 cm(2). The time from onset of sore to admission ranged from 3 months to 22 years (mean = 35.5 months, s.d. ± 55.8). Local preoperative preparation included external skin traction using adhesive tapes, wound cleaning and change of dressing. General condition was checked and improved by supportive measures. Operation procedures included thorough debridement, excision of hidden minor scars, mobilizing opposing skin flaps and meticulous haemostasis before closure. Skin traction continued after the operation until the wound was healed. RESULTS All but 10 sores healed primarily. These 10 sores healed after a revision. The length of stay in hospital ranged from 20 to 140 days (mean = 45.1 days, s.d. ± 21.1). Follow-up period was 2-51 months (mean = 22 months, s.d. ± 12.5). Two ischial sores recurred owing to long sitting. They were cured with the same method. Three illustrative cases are presented. CONCLUSION The method is simple and enjoys a high success rate with a short stay in hospital and hence is cost effective. The recurrence is rare.
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Affiliation(s)
- X Chen
- Nanjing Ruixin Hospital for Burns, Nanjing, PR China
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23
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Traction-Assisted Dermatogenesis by Serial Intermittent Skin Tape Application. Plast Reconstr Surg 2008; 122:1047-1054. [DOI: 10.1097/prs.0b013e3181858c68] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Surgical treatment of tattoos remains a useful tool for complete removal despite the availability of laser and other nonsurgical techniques. The procedures are in accordance with standard dermatosurgery used in aesthetic and oncologic therapies. Healing by primary intention or healing by secondary intention has its own indications. Skin defects can be closed by flaps, grafts, tissue extension, or tissue expansion.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany.
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25
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Canter HI, Jackson IT. Comment on "Closure of massive abdominal wall defects: a case report using the abdominal reapproximation anchor (ABRA) system". Ann Plast Surg 2007; 58:590; author reply 590-1. [PMID: 17452856 DOI: 10.1097/01.sap.0000258131.48729.dd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Londinsky M, Carriquiry CE. Cable ties: a simple device with multiple applications in plastic surgery. Plast Reconstr Surg 2007; 119:1142-3. [PMID: 17312554 DOI: 10.1097/01.prs.0000253461.06190.ec] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Bostrom B, Wilson H, Radlinsky M. The Use of an External Skin-Stretching Device for Wound Management in a Rabbit (Oryctolagus cuniculus). J Exot Pet Med 2006. [DOI: 10.1053/j.jepm.2006.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Marek DJ, Copeland GE, Zlowodzki M, Cole PA. The application of dermatotraction for primary skin closure. Am J Surg 2005; 190:123-6. [PMID: 15972184 DOI: 10.1016/j.amjsurg.2005.05.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible. This communication describes a technique that uses spinal needles, using towel clips and the natural stretching ability of the skin to enable primary closure of wounds. The technique described uses dermatotraction to stretch the skin is a cost-effective way to achieve primary closure of large wounds with supplies that are readily available in every operating room.
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Affiliation(s)
- Daniel J Marek
- Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, MN 55101, USA
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29
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Abstract
Although most equine wounds can be easily treated and heal without consequence, there are many that present special challenges. Skin grafts area valuable part of the veterinarian's armamentarium for treatment of complicated wounds, particularly limb wounds. Attention to preparation of the recipient site and proper aftercare are critical to successful grafting. With better understanding of equine wound and graft physiology and the promise foretold by advances in human skin grafting, the outcome of treatments of difficult equine wounds should continue to improve in the future.
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Affiliation(s)
- David G Bristol
- College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606, USA.
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30
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Lee ET. A New Wound Closure Achieving and Maintaining Device Using Serial Tightening of Loop Suture and its Clinical Applications in 15 Consecutive Patients for up to 102 Days. Ann Plast Surg 2004; 53:436-41. [PMID: 15502458 DOI: 10.1097/01.sap.0000130704.17323.ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A device that can both achieve and maintain wound closure by serial tightening of a loop suture was developed. The device consists of 3 components: a hollow plastic cylinder with a 1-way locking mechanism, a flat plastic strip passing though the cylinder, and a plastic cushion between the cylinder and the skin. The body of the device is composed of a soft cylinder and a hard strip. This difference in flexibility enables the device to absorb impacts of positional changes and daily activities, while the device preserves tension of loop suture and wound closure ().(Figure is included in full-text article.)After debridement or excision of a lesion, the passage of 0-1 nylon suture is designed. The nylon suture is threaded through the deep dermis across the wound. Both ends of the suture are then tied to make a loop, which is secured to 2 holes at one end of a plastic strip. The plastic strip, which holds the loop suture, is pulled away from the skin gradually through a hollow plastic cylinder to approximate wound margins ().(Figure is included in full-text article.)From January 2003 to August 2003, the device was applied 21 times in 15 consecutive patients. A mean stretching of 42.0 mm was performed for defects with a mean shortest dimension of 24.5 mm (from 2 mm to 60 mm). All 21 wounds were closed primarily (21/21 = 100%), and the closure was maintained successfully for 18 wounds (18/21 = 85.7%) in 13 patients (13/15 = 86.7%). The device was left in situ for as long as 102 days (average application time of 34.5 days). Three wound dehiscences (3/21 = 14.3%) occurred in 2 diabetic foot patients, which were cured by skin grafting. In 2 sacral pressure ulcer patients, minimal skin lacerations were caused by the loop sutures at the skin entrance site but without true wound dehiscence. These lacerations healed with minimal debridement and routine wound dressing within 2 weeks. This instrument was devised to overcome the limitations of previous skin stretching methods. It has wider indications and shows better compliances. In particular, because of its longer period of application, the device does not only stretch the skin to achieve wound closure, but also helps maintain it during wound healing.
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Affiliation(s)
- Eui-Tai Lee
- From the Department of Plastic and Reconstructive Surgery, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
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31
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Fan J, Wang J. The "silicone suture" for tissue expansion without an expander: a new device for repair of soft-tissue defects after burns. Plast Reconstr Surg 2004; 114:484-8; discussion 489-90. [PMID: 15277818 DOI: 10.1097/01.prs.0000132672.66547.b9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jincai Fan
- Division of Plastic Surgery and Hair Transplantation Center, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, Beijing, China.
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32
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Taylor RC, Reitsma BJ, Sarazin S, Bell MG. Early results using a dynamic method for delayed primary closure of fasciotomy wounds. J Am Coll Surg 2003; 197:872-8. [PMID: 14585431 DOI: 10.1016/s1072-7515(03)00646-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rebecca C Taylor
- Division of General Surgery, University of Ottawa, Ottawa, ON, Canada
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Chandawarkar RY, Cervino AL, Pennington GA. Intraoperative acute tissue expansion revisited: a valuable tool for challenging skin defects. Dermatol Surg 2003; 29:834-8. [PMID: 12859384 DOI: 10.1046/j.1524-4725.2003.29218.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The efficacy of acute tissue expansion (ATE) in achieving skin closure has been strongly debated. Proponents maintain that ATE is efficacious, whereas critics have argued for lack of supporting scientific data and that ATE is no more effective than skin undermining in closure of surface defects. OBJECTIVE To compare and actually quantify gain in skin length after extensive undermining of skin edges alone or in combination with ATE in skin defects. METHODS Twenty-one consecutive patients undergoing excision and closure of wounds in certain anatomical areas where primary closure is difficult were studied. Actual measurements of the undermined skin before and after ATE were recorded. Immediate problems and long-term follow-up data were analyzed. RESULTS ATE, in addition to undermining, provides 1:1.61 +/- 0.23 more skin on each margin than undermining used alone. It is effective, easy to perform, inexpensive, and reproducible, with clearly quantifiable increments of skin stretch. Long-term morbidity is minimal with excellent cosmetic results. CONCLUSION ATE provides a useful tool for closure of skin defects that are resistant to simple primary closure even when deeply undermined. It is simple and easily performed in an office setting without much preparation or special equipment.
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Affiliation(s)
- Rajiv Y Chandawarkar
- Division of Plastic Surgery, Summa Health System, Akron General Medical Center, Crystal Clinic, Ohio, USA.
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35
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Kiliç A. Presutured purse-string suture and second purse-string suture for both reduction and closure of skin defects. Plast Reconstr Surg 2002; 109:1758-60. [PMID: 11932646 DOI: 10.1097/00006534-200204150-00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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McCauley CT, Hawkins JF, Adams SB, Fessler JF. Use of a carbon dioxide laser for surgical management of cutaneous masses in horses: 32 cases (1993-2000). J Am Vet Med Assoc 2002; 220:1192-7. [PMID: 11990967 DOI: 10.2460/javma.2002.220.1192] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine outcome of horses in which cutaneous masses were removed with a carbon dioxide laser. DESIGN Retrospective study. ANIMALS 32 horses. PROCEDURE Medical records of horses with 1 or more cutaneous masses treated with a carbon dioxide laser were examined. Follow-up information was obtained through telephone interviews with owners and referring veterinarians. RESULTS Cutaneous masses were classified as sarcoids (15 horses), neoplastic masses other than sarcoids (squamous cell carcinoma [91; fibroma [1]; and melanoma [1]), and nonneoplastic masses (6). Minimum follow-up time was 6 months. Five sarcoids and 2 squamous cell carcinomas recurred. Seven (21%) horses had complications associated with dehiscence of wounds that had been closed primarily or failure of wound healing because of recurrence of the mass. Twenty-six (81%) owners were satisfied with the cosmetic appearance following surgery. CONCLUSION AND CLINICAL RELEVANCE Results suggest that a carbon dioxide laser may be effective for treatment of cutaneous masses in horses.
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Affiliation(s)
- Charles T McCauley
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1248, USA
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37
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Abstract
Large defects may at first appear to be too big to close in a side-to-side fashion. Certain wounds and situations may call for healing with second intent. Undermining and pulley sutures are very helpful in bringing together wound edges of certain large openings. Partial closures may decrease the tendency to exert unwanted tension against a free margin, decrease the size of the wound allowed to heal with second intent, shorten the duration of healing, and keep scars within one cosmetic unit. Buried sutures should be placed and laid beside the wound without tying the knot until the surface stitches or the external device approximates the wound edges. In this way, one can be certain that the buried stitch will provide adequate support to the infrastructure of the wound. Intraoperative skin expansion may help close wounds that could not be closed by any other technique except for skin grafting.
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Affiliation(s)
- R M Shelton
- New York Aesthetic Center, LLP, Department of Dermatology, Mount Sinai Medical Center, New York, New York, USA
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38
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Melis P, Noorlander ML, Bos KE. Tension Decrease during Skin Stretching in Undermined versus Not Undermined Skin: An Experimental Study in Piglets. Plast Reconstr Surg 2001; 107:1201-5; discussion 1206-7. [PMID: 11373562 DOI: 10.1097/00006534-200104150-00016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In a controlled study using 15 piglets, the efficacy of skin stretching using a skin stretching device was tested by quantifying the tension decrease during skin stretching in undermined and not undermined wounds. The viability of the skin margins was examined in both situations. Thirty standardized wounds was created: around 15 wounds on one flank, the surrounding skin was undermined; whereas around the 15 wounds on the opposite flank, the surrounding skin was not undermined. The force required to close the 9 x 9 cm defect was measured at the beginning, after undermining, and after 30 minutes of skin stretching. Also examined was the wound healing after 1 day and 1 week. A tension decrease of 3.02 N (13.6 percent reduction of the total force that is required to close the wound at the beginning) was seen due to undermining the surrounding skin. Skin stretching for 30 minutes without undermining the skin showed a tension decrease of 6.10 N (26.5 percent). Therefore, the tension decrease due to skin stretching was twice as high in comparison with undermining the skin margins alone. This has been statistically proven to be significant (-d (difference) = 3.08, 95 percent confidence interval = 2.16; 4.00, p < 0.001). When the undermined skin of the wound was stretched for 30 minutes, we measured a total tension decrease of 7.60 N (34.1 percent). There was a statistically significant but small difference in total tension decrease as a result of undermining combined with skin stretching in comparison with skin stretching without undermining (-d = 1.51, 95 percent confidence interval = 0.77; 2.23, p < 0.001). Undermining the surrounding skin involved cutting musculocutaneous perforating vessels. Looking at the viability of the skin, seven wounds, all found in the undermined group, showed skin necrosis after 1 week. Excessive seroma formation was seen in all wounds around which the skin was undermined. In the not undermined wounds, there were no problems in wound healing. In conclusion, skin stretching for only 30 minutes using a skin stretching device significantly reduces wound closing tension. The additional advantage of skin stretching over that of undermining alone is clearly shown. Undermining the wound margins before skin stretching gives a small additional tension decrease but has well-known complications, such as skin-edge necrosis and seroma formation.
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Affiliation(s)
- P Melis
- Department of Plastic, Reconstructive, and Handsurgery, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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39
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Effective Management of Difficult Surgical Defects Using Tissue-Engineered Skin. Dermatol Surg 2001. [DOI: 10.1097/00042728-200101000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Tarlow MM, Nossa R, Spencer JM. Effective Management of Difficult Surgical Defects Using Tissue-Engineered Skin. Dermatol Surg 2001. [DOI: 10.1111/j.1524-4725.2001.00183.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Pavletic MM. Use of an external skin-stretching device for wound closure in dogs and cats. J Am Vet Med Assoc 2000; 217:350-4, 339. [PMID: 10935038 DOI: 10.2460/javma.2000.217.350] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Use of an externally applied, noninvasive skin-stretching device in 24 dogs and cats is described. The device uses adhesive-coated pads that are applied to the skin of an animal; pads are positioned on opposite sides of a surgical site and are connected by means of adjustable elastic cables. The cables maintain continuous tension, and cable tension is adjusted and progressively increased at intervals of 6 to 8 hours to promote skin recruitment (stretching), using the cutaneous viscoelastic properties of mechanical creep and stress relaxation. Consequently, skin adjacent and distant to the surgical site can be recruited to facilitate wound closure, typically within 72 to 96 hours after application of the device. The skin-stretching device has been used effectively in dogs and cats to stretch skin prior to elective surgical procedures, stretch skin during management of open wounds prior to suturing, and alleviate incisional tension after surgery.
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Affiliation(s)
- M M Pavletic
- Department of Surgery, Angell Memorial Animal Hospital, Boston, MA 02130, USA
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43
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Abstract
We describe the use of a "lacing apparatus" across large and complex wounds to accomplish wound closure. This technique utilizes the principles of tissue expansion (exploiting inherent extensibility of the skin, mechanical creep, and biologic creep) but is able to employ them in situations in which traditional tissue expansion (utilizing implantable expanders) is not practical. After preparation, the wounds are laced with large nylon suture, which is tightened on a daily basis, typically allowing closure of even massive wounds within 8 to 10 days. In this report, we describe the technical details of wound preparation, application of the lacing apparatus, and postoperative execution of the expansion leading to final wound closure. This technique is particularly valuable in the upper arm, trunk, and lower extremity but has limited application in the distal forearm and the distal third of the lower extremity.
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Affiliation(s)
- M J Concannon
- Division of Plastic Surgery, University of Missouri-Columbia 65212, USA
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44
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Melis P, Bos KE, Horenblas S. Primary skin closure of a large groin defect after inguinal lymphadenectomy for penile cancer using a skin stretching device. J Urol 1998; 159:185-7. [PMID: 9400468 DOI: 10.1016/s0022-5347(01)64052-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We describe a method of primary closure of a large skin defect. MATERIALS AND METHODS A 44-year-old man was treated for penile cancer. After left inguinal lymphadenectomy a large skin defect in the groin remained that could not be closed primarily. Allowing skin to stretch beyond its inherent extensibility with a skin stretching system (Sure-Closure) the wound edges were closed without tension. RESULTS Primary closure of a large skin defect was possible after cyclic stretching and relaxation of the skin with a skin stretching device. CONCLUSIONS Large skin defects can be closed primarily using a skin stretching device. The primary advantage of the procedure are its simplicity and avoidance of the need for more complicated reconstructive surgery.
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Affiliation(s)
- P Melis
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
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45
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Tremolada C, Blandini D, Beretta M, Mascetti M. The "round block" purse-string suture: a simple method to close skin defects with minimal scarring. Plast Reconstr Surg 1997; 100:126-31. [PMID: 9207671 DOI: 10.1097/00006534-199707000-00023] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the use of a subcuticular purse-string suture for closure of surgical skin defects, a simple maneuver that we have found to be very useful in closing difficult wounds and reducing scarring. The purse-string suture is performed with a large nonabsorbable suture that is passed intradermally and left in situ at least 4 weeks. This technique has been applied in 196 patients for a total of 221 sutures over a period of 2 years, being used to close skin defects from 2 x 2 to 8 x 11 cm in many areas of the body. All the patients showed, at closure, a large number of concentric redundant folds as well as considerable distortion of nearby structures; both improved impressively over a period of 2 to 3 weeks and became nearly normal at the time of suture removal (4 to 8.2 weeks, mean 5.7 weeks). The initially very limited and almost circular scar oriented itself along the skin tension lines over a period of a few weeks and, when matured, was always shorter than the original defect. In general, minimal scar widening occurred when we used larger sutures (more than 0-1) that were left longer (more than 6 weeks). Complications have been 23 cases of dehiscence (10.4 percent) in 23 patients (between the fifth and sixteenth days, mean 6.7 days); they were caused by the bad quality of the skin and by the use of too small sutures that cut through the dermis. The "round block" suture has many advantages: 1. It is a simple, inexpensive, and rapid technique for closing wounds by expanding the surrounding skin and often avoiding the use of skin grafts and/or local flaps. 2. It can minimize scarring; the final scars are shorter than the original defect and usually of very good quality. 3. It allows a very useful temporary closure that stretches the surrounding skin while waiting for the definitive histologic report. If this method is not chosen as a definitive closure, later repair with local flaps may be facilitated. 4. For the reasons expressed above, it never compromises the final result even in cases of dehiscence. The main disadvantage is the acceptability of the method on the part of patients, who need to be carefully prepared for both the gross initial distortion and the long time the suture has to be retained; nevertheless, patient satisfaction with the final results in generally very high, especially in large excisions of the face.
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Affiliation(s)
- C Tremolada
- Department of Plastic Surgery, Ospedale Maggiore di Lodi, Milan, Italy
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46
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Fan J, Eriksson M, Nordström RE. External device for tissue expansion: clinical evaluation of the skin extender. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1996; 30:215-20. [PMID: 8885018 DOI: 10.3109/02844319609062818] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tissue expansion is a well known way of repairing soft tissue defects. However, traditional tissue expanders have certain disadvantages such as the need for repeated outpatient visits for the filling of the expander and a long period of time required before the final result is achieved. A series of other devices have recently been developed. We have evaluated one of these, a skin extender developed by Blomqvist and Steenfos, in 10 lesions of the extremities in nine adult patients. The defects ranged from 3.5-10 cm wide and the extenders were inserted under local anaesthesia. The patients were taught how to tighten the extenders themselves, so there was no need for repeated visits to the outpatient department. Nine of the 10 defects were excised within 14 days; the remaining one developed a wound infection. The results show that this skin extender is a simple, fast, and economical device for repairing soft tissue defects, and in certain cases it is more suitable than a traditional tissue expander. Its major drawback is unsightly scars in the normal skin beside the previous defect.
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Affiliation(s)
- J Fan
- Department of Plastic and Reconstructive Surgery, University Hospital, Tromsø, Norway
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Stahl S, Har-Shai Y, Hirshowitz B. Closure of wounds in the upper extremity using a skin stretching device. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1996; 21:534-7. [PMID: 8856548 DOI: 10.1016/s0266-7681(96)80060-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A skin stretching device (SSD) harnessing the viscoelastic properties of skin using incremental traction has been used in 20 patients with skin deficits in the upper extremity. Complications were few considering the extensive damage to the skin and included slight partial dehiscence, necrosis of skin edges, local infection and hypertrophic scars. All wounds healed without the need for further surgical procedures. Application of the SSD is simple and it can even be used at the bedside under local anaesthesia. It reduces the need for more complicated surgical procedures like grafts or flaps.
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Affiliation(s)
- S Stahl
- Hand Surgery Unit, Rambam Medical Center, Haifa, Israel
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48
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Narayanan K, Latenser BA, Jones LM, Stofman G. Simultaneous primary closure of four fasciotomy wounds in a single setting using the Sure-Closure device. Injury 1996; 27:449-51. [PMID: 8881149 DOI: 10.1016/0020-1383(96)00029-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K Narayanan
- Department of Surgery, Mercy Hospital of Pittsburgh, PA 15213, USA
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49
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50
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Neves RI, Saggers GC, Mackay DR, Manders EK. Assessing the role of presuturing on wound closure. Plast Reconstr Surg 1996; 97:807-11; discussion 812-4. [PMID: 8628776 DOI: 10.1097/00006534-199604000-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The efficacy of presuturing was tested by quantitating the tissue gains for standardized wounds in a white swine piglet (9 to 11-kg) model. Also measured were the changes in wound closure tension for the wounds. Measurements were carried out at 1, 4, 17, 24, 48, and 72 hours in a total of 20 piglets. Presuturing was carried out on one of the flanks and the opposite flank served as the control. Presuturing achieved a modest tissue gain, amounting to 67 mm at 4 hours and a maximum of 1.4 cm at 48 and 72 hours, for a 4-cm defect. The encouraging tissue gain was unfortunately not paralleled by a decrease in the tension required to approximate the wound edges. At 4 hours, the tension to close the wound was 1.2 N (only 120 g) less than the control wound. This initial small reduction in wound-closing tension was diminished thereafter, and at 72 hours the wounds were stiffer and harder to close than the control. This appeared to be due to tissue edema and was confirmed by an increase in measurable tissue water with increasing time. In this model, presuturing produces a minimal tissue advancement and even less reduction in wound-closing tension. It is concluded, from this work and from previously published work, that undermining will prove generally to be a more useful technique in closing broad defects.
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Affiliation(s)
- R I Neves
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Pennsylvania State University College of Medicine, USA
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