Presuturing--a new technique for closing large skin defects: clinical and experimental studies

Intra-operative scalp expansion for wound closure without tension in craniosynostosis operation--technical innovation

Primary scalp wound closure using intra-operative scalp expansion in a craniosynostosis operation is described. Since this method enables easy scalp expansion, it is considered to be a useful adjunctive technique which should be taken into account when closing scalp wounds in craniosynostosis surgery, where the risk exists of cranial expansion-induced compression and deformity of the remodelled bone flaps after bone fixation.

Closure of an open high below-knee guillotine amputation wound using a skin-stretching device

A skin-stretching device (SSD) which is designed to harness the viscoelastic properties of the skin using incremental traction is described. It has proved to be of value in securing closure, within 72 h, of an open high below-knee guillotine stump wound which did not heal during a period of 2 months after amputation. The skin-stretching device provided healthy, durable and sensate skin for stump coverage. Hospitalization time was shortened and an early post-surgical prosthetic fitting and ambulation was achieved.

Exploiting the viscoelastic properties of pedal skin with the Sure Closure skin stretching device

This manuscript introduces a device for harnessing the inherent viscoelastic properties of skin, to mechanically assist primary and delayed primary wound closure. The current indications, contraindications, and general use of the device are discussed. Also included is an initial series of device applications, with two case reports reviewed in detail.

A scalp garment for prestretching prior to alopecia-reducing procedures

BACKGROUND

This article demonstrates a scalp stretching device that improves scalp laxity prior to alopecia reducing procedures. This device replaces the former use of vigorous, preoperative scalp stretching exercises.

OBJECTIVE

To improve scalp laxity prior to alopecia-reducing procedures by using a device rather than vigorous prestretching exercises, which are physically fatiguing.

METHOD

A scalp stretching device was developed that uses the principle of cyclic loading in the immediate preoperative period and the principle of biologic creep during the month prior to the procedure. This device is simply applied by patients at home for 30 minutes per day starting 30 days before an alopecia-reducing procedure.

RESULTS

The device demonstrates ease of use for the patients and does not require any physical activity on their part. It accomplishes the same improvement in laxity that prestretching exercises formerly achieved.

CONCLUSION

The scalp stretching garment introduced improves the laxity of the scalp prior to alopecia-reducing procedures with no physical exertion being required by the patient.

Pexing and presuturing for closure of traumatic soft tissue injuries

The technical values of pexing and presuturing have been confirmed for tumor surgery. Extrapolation of these techniques to the trauma patient has proven worthwhile. This article reviews these methods and presents cases as examples.

Comparison of skin hooks and Foley catheters for immediate tissue expansion

BACKGROUND

Immediate tissue expansion has been reported to expand skin sufficiently to permit primary closure of large facial defects up to 5 cm in diameter.

OBJECTIVE

We wished to evaluate and compare skin hooks with foley catheters in producing tissue expansion.

METHODS

Seven patients with post-Mohs surgery defects measuring 3.0 to 5.5 cm in diameter and located on scalp, temple, or forehead skin were treated with immediate tissue expansion.

RESULTS

Immediate tissue expansion provided a 16 to 36% increase in the tissue available for closure, over and above what was achieved by undermining alone. In each case, adequate stretching of skin was achieved to permit primary closure relatively easily, which was not possible with undermining alone. Skin hooks were found to be equivalent to foley catheters in their ability to produce tissue expansion. At the one year follow-up visit, some spreading of the scar was noted, ranging from 1 to 7 mm, which appears in part to be related to the degree to which the skin was expanded.

CONCLUSION

These findings support the concept that immediate tissue expansion is a separate and distinct process from undermining, which provides additional tissue for reconstructive surgery.

Mohs surgery update. Intraoperative presuturing

During the course of Mohs surgery, the surgeon may be able to predict that the final closure may require tissue expansion or some other extraordinary measure to close a defect on a particular location. Presuturing, the use of stitches to preoperatively stretch donor tissue peripheral to the wound, has been previously advocated to aid in the primary closure of nonMohs tumor removal defects and scalp reduction defects. We describe the anticipatory need for and the use of button bolstered nonabsorbable sutures to stretch or expand the perioperative tissues for final closure. Previously unreported in the literature, we also employ this technique prior to flap closure. This quick and easy manouever following the intermediate and final stages of Mohs surgery has seen great use in the care of some relatively large tumors.

The suture tension adjustment reel. A new device for the management of skin closure

The initial clinical experience with a new device, called the Suture Tension Adjustment Reel (STAR), is described. The historical precedence and rationale underlying linear tissue expansion is presented. Case reports illustrate the use of the STAR for preoperative tissue stretching, for intraoperative tissue stretching, and for tissue mobilization as applied to scalp reduction surgery. The multipurpose device is a safe, simple, and reliable adjunct to sutured surgery. It is of value in the general management of tensioned and nontensioned skin closures.

Presuturing in rhytidectomy: a case report

The use of intraoperative tissue expanders or staged skin excision to improve the results of facelift surgery has been previously reported. However, it is debatable whether excess skin excision improves the final result of rhytidectomy. To determine whether increased skin excision without increased skin tension on the suture line could improve the final results of facelift surgery, a unilateral presuturing technique was used on one patient. Equal bilateral skin tension at the suture line, checked with a spring dynamometer, resulted in a marked increase in the amount of skin excised on the presutured side. No significant difference was noted initially after the operation, but the results at six weeks and at one year after surgery were felt by both patient and physician to be slightly better on the presutured side.

Presuturing in alopecia reductions

The technique of presuturing for alopecia reductions is described. With this procedure, the area of potential reduction is sutured 12-24 hours prior to surgery to enhance the laxity of the scalp.

Tissue expansion

Although tissue expansion is unlikely to replace skin grafting and other basic reconstructive procedures in the horse, its continued success in humans will undoubtedly stimulate client interest in its use. Its biggest advantage is the advancement of full-thickness skin over large defects where grafting techniques would not provide the same degree of protection. The resulting cosmetic appearance of the wound is also better.

Techniques of wound closure

Although many wounds in horses heal successfully by second-intention healing or delayed closure, some wounds can be sutured primarily, with reasonably high expectations of first-intention healing. To expect to achieve these results, one needs to have a rational treatment plan. Such a plan should be based on a working knowledge of the biology of tissue repair and tissue infection. Treatment decisions should be based more on results of experimental and clinical trials rather than on testimonials of other practitioners.