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Huang J, Chen H, Jia Z, Song X, Wang S, Bai B, Wang J, Zhang J, Zhou G, Lei D. Mechanically skin-like and water-resistant self-healing bioelastomer for high-tension wound healing. Bioact Mater 2024; 39:443-455. [PMID: 38873087 PMCID: PMC11170441 DOI: 10.1016/j.bioactmat.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 06/15/2024] Open
Abstract
The biomedical application of self-healing materials in wet or (under)water environments is quite challenging because the insulation and dissociation effects of water molecules significantly reduce the reconstruction of material-interface interactions. Rapid closure with uniform tension of high-tension wounds is often difficult, leading to further deterioration and scarring. Herein, a new type of thermosetting water-resistant self-healing bioelastomer (WRSHE) was designed by synergistically incorporating a stable polyglycerol sebacate (PGS) covalent crosslinking network and triple hybrid dynamic networks consisting of reversible disulfide metathesis (SS), and dimethylglyoxime urethane (Dou) and hydrogen bonds. And a resveratrol-loaded WRSHE (Res@WRSHE) was developed by a swelling, absorption, and crosslinked network locking strategy. WRSHEs exhibited skin-like mechanical properties in terms of nonlinear modulus behavior, biomimetic softness, high stretchability, and good elasticity, and they also achieved ultrafast and highly efficient self-healing in various liquid environments. For wound-healing applications of high-tension full-thickness skin defects, the convenient surface assembly by self-healing of WRSHEs provides uniform contraction stress to facilitate tight closure. Moreover, Res@WRSHEs gradually release resveratrol, which helps inflammatory response reduction, promotes blood vessel regeneration, and accelerates wound repair.
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Affiliation(s)
- Jinyi Huang
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
- Research Institute of Plastic Surgery, Shandong Second Medical University, Weifang, Shandong, 261053, PR China
| | - Hongying Chen
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Zenghui Jia
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
- Research Institute of Plastic Surgery, Shandong Second Medical University, Weifang, Shandong, 261053, PR China
| | - Xingqi Song
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Sinan Wang
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Baoshuai Bai
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Jian Wang
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Junfeng Zhang
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
- Research Institute of Plastic Surgery, Shandong Second Medical University, Weifang, Shandong, 261053, PR China
| | - Dong Lei
- Department of Plastic and Reconstructive Surgery, Department of Cardiology, Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
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Comino F, Pollock PJ, Fulton I, Hewitt-Dedman C, Handel I, Gorvy DA. A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension. Equine Vet J 2024; 56:514-521. [PMID: 37559442 DOI: 10.1111/evj.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. OBJECTIVE To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. STUDY DESIGN Retrospective case series. METHODS All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. RESULTS During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. MAIN LIMITATIONS Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. CONCLUSIONS The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.
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Affiliation(s)
- Francesco Comino
- SLU University Animal Hospital (UDS), Equine Hospital, Uppsala, Sweden
| | - Patrick J Pollock
- The University of Edinburgh Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Ian Fulton
- Ballarat Veterinary Practice, Victoria, Australia
| | | | - Ian Handel
- The University of Edinburgh Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Dylan A Gorvy
- SLU University Animal Hospital (UDS), Equine Hospital, Uppsala, Sweden
- Mälaren Hästklinik, Sigtuna, Sweden
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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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Guo H, Wang X, Gao Z, Feng L. The incision can't be sutured after modified radical mastectomy: What else can we do? Asian J Surg 2024; 47:606-608. [PMID: 37805318 DOI: 10.1016/j.asjsur.2023.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Honggang Guo
- Department of Plastic Surgery, Linyi People's Hospital, Shandong Province, China
| | - Xiuxiu Wang
- Second Department of Internal Medicine, Linyi Cancer Hospital, Shandong Province, China
| | - Zhongcheng Gao
- Department of Breast Surgery, Linyi People's Hospital, Shandong Province, China.
| | - Liyong Feng
- Department of Breast Surgery, Linyi People's Hospital, Shandong Province, China.
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Choudhary AN, Kumar S. Cable Ties: Poor Man's Top Closure System. Indian J Plast Surg 2023; 56:182-184. [PMID: 37153335 PMCID: PMC10159720 DOI: 10.1055/s-0043-1761179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Scalp electrical burns unsuitable for primary closure after debridement have traditionally been treated by modalities that cause significant morbidity and are aesthetically inferior to tension-free primary wound closure. Due to advances in research on the biomechanical properties of skin, various devices for skin stretching and safe wound closure have been reported in the literature that are expensive and inaccessible to poor people in the developing countries. We present our experience using cable ties as an effective, easy to use, readily available, and inexpensive top closure system.
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Affiliation(s)
- Aditya Narayan Choudhary
- Plastic Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
- Address for correspondence Aditya Narayan Choudhary, MCh Plastic Surgery, Heritage Institute of Medical SciencesVaranasi 221311, Uttar PradeshIndia
| | - Sanjeev Kumar
- Plastic Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Vathulya M, Rao S, Malik A, Sinha S, Kumar N, Kapoor A, Bahurupi Y. Is "Initial Size of the Graft the Real Culprit behind Primary Contraction of Full-Thickness Skin Graft"? - A Cross-Sectional Study. Arch Plast Surg 2023; 50:106-115. [PMID: 36755654 PMCID: PMC9902097 DOI: 10.1055/s-0042-1756297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 02/09/2023] Open
Abstract
Background Primary contraction of full-thickness graft has been traditionally quoted to be 40%. There are lacunae in literature to elaborate on the factors influencing it ever since. Methods About 75 subjects who underwent full-thickness grafting procedures to resurface small defects were included in the study. The initial and final graft dimensions after primary contraction were traced on X-ray templates and the percentage of contraction was evaluated using the graphical method. This was further correlated with age, collagen, elastic matrix metalloproteinases-1 (MMP-1) and -2 content along with dermal thickness of the skin specimen sent from the graft. Results The primary contraction of the graft had a very significant correlation only with the initial size of graft harvested with a linear regression of 33.3% and a Spearman's correlation of 0.587 significant at a p -value of 0.001. Conclusion This study though preliminary tries to highlight an important factor that primary contraction of grafts is a physical phenomenon independent of its contents like collagen, elastin, or MMP-1 and -2 or age and dependent on its initial size of harvest instead.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence Madhubari Vathulya, MS, MCh Department of Burns and Plastic Surgery, All India Institute of Medical SciencesRishikesh 249203, UttarakhandIndia
| | - Shalinee Rao
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akanksha Malik
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Smita Sinha
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nikhilesh Kumar
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Topaz M, Chorin E, Schwartz AL, Hochstadt A, Shotan A, Ashkenazi I, Kazatsker M, Carmel NN, Topaz G, Oron Y, Margolis G, Nof E, Beinart R, Glikson M, Mazo A, Milman A, Dekel M, Banai S, Rosso R, Viskin S. Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections. J Am Coll Cardiol 2023; 81:119-133. [PMID: 36631206 DOI: 10.1016/j.jacc.2022.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections. OBJECTIVES The authors evaluated the efficacy of delivering continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction. METHODS The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy. RESULTS A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA. CONCLUSIONS CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction. (Salvage of Infected Cardiovascular Implantable Electronic Devices [CIED] by Localized High-Dose Antibiotics; NCT01770067).
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Affiliation(s)
- Moris Topaz
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Emeritus Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Ehud Chorin
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Shotan
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel; Heart Institute, Laniado Medical Center, Netanya, Israel; Adelson School of Medicine, Ariel University, Samaria, Israel
| | | | - Mark Kazatsker
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Guy Topaz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine, Meir Medical Center, Kfar Saba, Israel
| | - Yoram Oron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Margolis
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Glikson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel; Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University, Jerusalem, Israel
| | - Anna Mazo
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Milman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Dekel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Fan H, Jia H, Zhu Z, Zhao Y, Yu M. TopClosure® tension‑relief system improves clinical outcomes of patients with breast cancer undergoing mastectomy. Exp Ther Med 2022; 25:70. [PMID: 36605529 PMCID: PMC9798149 DOI: 10.3892/etm.2022.11769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
The present randomized controlled study aimed to investigate the effects of TopClosure® tension-relief system (TRS) on patients with breast cancer undergoing mastectomy. A total of 402 female patients with breast cancer who came to the Renmin Hospital of Wuhan University between March 2014 and June 2018 were involved in the present study. All patients receiving mastectomy were randomly divided into the TRS group (n=201) and the control group (n=201). Serum levels of high-sensitivity C-reactive protein, TNF-α, IL-6 and procalcitonin were measured using ELISA. Vancouver Scar Scale was recorded at 2 weeks and 1-3 and 6 months following the operation. The 36-Item Health Survey Scales were performed for all patients at 1 month after surgery. The TRS reduced the incidence of flap necrosis, infection and the duration of hospital stay. In addition, the TRS was found to attenuate inflammation and improve scar outcomes as well as the quality of life. It was concluded that the TRS could significantly improve the clinical outcomes.
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Affiliation(s)
- Huajun Fan
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Haizhen Jia
- Cardiovascular Department, Tianyou Hospital Affiliated To Wuhan University of Science and Technology, Wuhan, Hubei 430064, P.R. China
| | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yueqiang Zhao
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Mosheng Yu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China,Correspondence to: Dr Mosheng Yu, Department of Plastic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Street, Wuchang, Wuhan, Hubei 430060, P.R. China
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Wallace SB, Hamati M, Lendrum JA, Schultz L, Metzl J, Moon DK, Hunt KJ. Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty. Foot Ankle Int 2022; 43:1540-1547. [PMID: 36263464 DOI: 10.1177/10711007221120024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis, but it carries a known risk for wound complications. Several products have been investigated to mitigate this risk; however, most are either costly or invasive. Noninvasive skin expansion strips (NSESs) were designed to transfer tension away from the incision and induce new skin growth at the edges of the strips. We hypothesize that postoperative application of NSESs will decrease unplanned clinic visits and wound complications after TAR-AA. METHODS This is a prospective cohort study of 41 patients at a single institution (3 surgeons) treated with NSESs after undergoing TAR-AA. An additional 41 consecutive historical patients treated without NSESs were retrospectively included as a control group. Patients received application of NSESs in the operating room after routine wound closure and again 2 weeks postoperatively. No other changes were made to the surgeons' wound closure technique, immobilization, follow-up timing, or rehabilitation protocols. Primary outcomes included (1) additional clinic visit required for wound assessment or suture removal, (2) superficial wound complication, and (3) deep infection. RESULTS Baseline demographics did not differ significantly from our 41 consecutively treated historical controls. Additional clinic visits for suture removal or wound evaluation were significantly lower for patients treated with NSESs (15%, 6 of 41) compared to the control group (49%, 20 of 41) (P = .001). There was also a significant difference in the superficial wound complication rate in the treatment group vs control group, 2% and 12%, respectively (P = .04). There were no deep infections in either group. CONCLUSION Noninvasive skin expansion strips placed after TAR-AA with an anterior approach have the potential to decrease wound complications and unplanned clinic visits. Further high-volume or randomized studies are needed to clarify their cost effectiveness and effect on long-term outcomes. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Stephen Blake Wallace
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary Hamati
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Alexander Lendrum
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lindsey Schultz
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua Metzl
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel K Moon
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth J Hunt
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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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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Li Y, Xing JH, Yang Z, Xu YJ, Yin XY, Chi Y, Xu YC, Han YD, Chen YB, Han Y. Tension-reduced closure of large abdominal wall defect caused by shotgun wound: A case report. World J Clin Cases 2022; 10:10713-10720. [PMID: 36312484 PMCID: PMC9602223 DOI: 10.12998/wjcc.v10.i29.10713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/19/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Large abdominal wall defect (LAWD) caused by shotgun wound is rarely reported.
CASE SUMMARY Herein, we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages, including debridement, tension-reduced closure (TRC), and reconstruction with mesh and a free musculocutaneous flap. During a 3-year follow-up, the patient recovered well without hernia or other problems.
CONCLUSION TRC is a practical approach for the temporary closure of LAWD, particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.
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Affiliation(s)
- Yan Li
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jia-Hua Xing
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Zheng Yang
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yu-Jian Xu
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xiang-Ye Yin
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yuan Chi
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Yi-Chi Xu
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yu-Di Han
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - You-Bai Chen
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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12
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郭 浩, 汤 俊, 张 军, 毕 争, 李 双, 胡 星, 陈 华, 唐 佩. [Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:760-765. [PMID: 35712935 PMCID: PMC9240850 DOI: 10.7507/1002-1892.202201068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/17/2022] [Indexed: 01/24/2023]
Abstract
Objective To observe the effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close. Methods The clinical data of 13 patients with skin and soft tissue defects that were difficult to close treated with disposable skin stretch closure and met the selection criteria between July 2021 and February 2022 were retrospectively reviewed. There were 9 males and 4 females, the age ranged from 15 to 71 years with a mean of 39.8 years. The causes of injury included falling injury in 5 patients, traffic accident injury in 5 patients, and falling from height injury in 3 patients. The causes of skin soft tissue defects included open fractures in 4 patients, wound infection in 4 patients, osteomyelitis in 3 patients, degloving injury in 1 patient, and necrosis of skin graft in 1 patient. The injury was located at calf in 8 patients, calcaneus in 3 patients, pelvis in 1 patient, and plantar in 1 patient. The skin and soft tissue defects ranged from 5.0 cm×2.0 cm to 10.5 cm×6.5 cm. Wound conditions (wound closure and wound healing) and the presence or absence of complications were recorded. Results All 13 patients were followed up 32-225 days with a median of 164 days. The wound closure time ranged from 5 to 14 days, with a mean of 8.8 days. The wound closure speed ranged from 0.7 to 13.7 cm 2/day, with a mean of 3.6 cm 2/day. All wounds healed at grade A, and no complication such as skin edge injury, wound necrosis, infection, dehiscence, and edema occurred. No patient complained of pain or discomfort, and no obvious scarring was found during follow-up. The wound healing time ranged from 17 to 28 days, with a mean of 21.7 days. One of them was transferred to other department due to lung cancer condition changes after using disposable skin stretch closure, and the wound had directly healed without suturing at 17 days after operation. Conclusion The effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close was exact, with short wound closure time, few complications, and easy operation.
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Affiliation(s)
- 浩 郭
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
- 武警北京市总队医院外二科(北京 100027)The Second Surgical Department, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force, Beijing, 100027, P. R. China
| | - 俊君 汤
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - 军 张
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - 争 毕
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - 双成 李
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
- 武警北京市总队医院外二科(北京 100027)The Second Surgical Department, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force, Beijing, 100027, P. R. China
| | - 星星 胡
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - 华 陈
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - 佩福 唐
- 中国人民解放军总医院研究生院(北京 100853)Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China
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Wolf Y, Hagen BR, Yafe B, Golan J, Shulman O, Har-Shai Y, Neuman R. The History of Plastic Surgery in Israel. Semin Plast Surg 2022; 36:120-130. [DOI: 10.1055/s-0042-1750189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractToday, plastic surgery is a well-known profession with highly respected surgeons from institutions all over the world. Over the last several decades numerous clinical and technological advances have been made, thanks to the dedication and hard work of these outstanding professionals; however, things were not always this way. At the turn of the 20th century, Israel had yet to be introduced to the field of plastic surgery. However, this all changed with the War of Independence. Humanitarian aid by the prominent South African surgeon, Jack Penn, laid the foundation for the founding fathers of plastic surgery in Israel to establish a strong legacy of producing world-renowned surgeons and innovators. Through this paper, we hope to provide a brief overview of the history of plastic surgery in Israel and what transpired to give us the state of surgical practice we have today.
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Affiliation(s)
- Yoram Wolf
- Plastic Surgery Unit, Hillel Yaffe Medical Center, Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Hadera, Haifa, Israel
| | | | - Batya Yafe
- Department of Hand Surgery and Microsurgery Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Golan
- Department of Plastic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ori Shulman
- Department of Plastic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yaron Har-Shai
- Department of Plastic Surgery, Carmel and Lin Medical Centers, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Rami Neuman
- Department of Plastic Surgery, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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14
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Har-Shai L, Ofek SE, Cohen S, Cohen KH, Yaacobi DS, Olshinka A, Dibbs RP, Ad-El DD. Israeli Innovations in the Field of Plastic Surgery. Semin Plast Surg 2022; 36:55-65. [DOI: 10.1055/s-0042-1748916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractNumerous innovations within the field of plastic surgery have been developed in Israel over the last few decades. Many of these therapeutic devices and techniques have been established globally with demonstrable efficacy and respectable safety profiles. This article offers an overview of recent Israeli cutting-edge medical therapeutic solutions contributing to the global practice of plastic surgery.
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Affiliation(s)
- Lior Har-Shai
- Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sar-El Ofek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stav Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren H. Cohen
- Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Shilo Yaacobi
- Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Olshinka
- Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami P. Dibbs
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine. Houston, Texas
| | - Dean D. Ad-El
- Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Yaacobi DS, Topaz M, Kalish E, Hayun Y, Gurevich M, Ad-El D, Grush AE, Olshinka A. Pediatric Wound Closure by a Tension-Relief System. Semin Plast Surg 2022; 36:83-88. [PMID: 35937437 DOI: 10.1055/s-0042-1748915] [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: 10/16/2022]
Abstract
Surgical reconstruction in pediatric patients can often be complex. Primary wound closure is almost always the preferred technique in the reconstructive ladder; however, it is not always possible in pediatric patients. We report the pediatric use of the TopClosure Tension-Relief System, an innovative skin-stretching technique for secure primary wound closure of large defects. We modified the technique by fixating it to a protective dressing instead of the patient's skin, thus avoiding both staple scars and pain. A retrospective review of 112 patients aged 7 days to 18 years who underwent Tension-Relief System-assisted surgery at a tertiary medical center from 2010 to 2020 was conducted. Cases included congenital deformities, traumatic wounds, burn scars, and complicated-wounds, with or without hardware or deep tissue exposure. The use of the system avoided the need for multiple surgical sessions and for local or regional flaps. The technique was simple to use, with few complications, and led to satisfactory aesthetic and functional outcomes. The findings support using the technique in children and adolescents with challenging tension wounds. Herein, we report on our experience with the Tension-Relief System and detail four cases in which early or immediate closure was successfully achieved.
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Affiliation(s)
- Dafna Shilo Yaacobi
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Eyal Kalish
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehiel Hayun
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gurevich
- Department of Transplantation, Rabin Medical Center- Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew E Grush
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Asaf Olshinka
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Olshinka A, Shay T, Amir A, Meshulam-Derazon S, Icekson M, Wadhawker S, Lvovsky A, Ad-El D, Yaacobi DS. Complicated Wound Closure Following Mastectomy and Breast Reconstruction. J Cosmet Dermatol 2022; 21:4572-4579. [PMID: 35029015 DOI: 10.1111/jocd.14772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/12/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
Breast reconstruction incidence increased, including preventive surgery. In this context, providing women best surgical care and results is crucial, with minimum complications, such as wound dehiscence and skin flap necrosis. Tension-free closure of skin flaps is mandatory for successful healing. However, since this is not always possible, various techniques have been developed to reduce tension from wound-margins, facilitate primary wound-closure, and minimize and improve scarring. These techniques have not been investigated in breast surgeries. The aim of this study was to describe our experience with the Tension-Relief System in mastectomy and breast reconstructive patients, and the advantages of using this technique. The retrospective cohort consisted of 13 breasts of 11 women aged 29-74 years who underwent surgery with primary wound-closure using the System, in 2019-2020 in our department. It was applied averagely 19.7 days, demonstrated effectiveness in preventing complications and as secondary treatment following complications. This enabled avoiding further and more extensive surgeries, including donor-site morbidity when needed. In mastectomy and breast-reconstruction, the System minimizes complications and yields satisfactory aesthetic and functional outcomes, with minimal inconvenience to the patient, and good pain-control. The technique is low-cost, simple to use, and does not require special settings, surgical equipment, or particular skills.
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Affiliation(s)
- Asaf Olshinka
- Senior Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Plastic Surgery & Burns Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Shay
- Senior Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aharon Amir
- Senior Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Meshulam-Derazon
- Senior Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Icekson
- Senior Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonya Wadhawker
- Senior Doctor, Breast Surgical Unit, Division of General Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alex Lvovsky
- Head of forensic identification department, Medical Corps, Israel Defense Forces, Israel
| | - Dean Ad-El
- Head of Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Shilo Yaacobi
- Resident Doctor, Department of Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Tong X, Lu J, Zhang W, Wang S, Huang R, Zhang X, Huang J, Zhu Y, Xiao S, Ji S, Xia Z. Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates. BURNS & TRAUMA 2022; 10:tkac045. [PMCID: PMC9741868 DOI: 10.1093/burnst/tkac045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/26/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Currently, various external tissue expansion devices are becoming widely used. Considering the scarcity of relevant application standards, this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects.
Method
A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted. A comprehensive search was performed in the following electronic databases: PubMed/Medline, Embase, Cochrane Library (Wiley Online Library), and Web of Science. Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included.
Results
A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria. We performed a descriptive analysis of different kinds of devices. A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies. The pooled mean wound healing time among patients with defects after fasciotomy was 10.548 days [95% confidence interval (CI) = 5.796–15.299]. The pooled median wound healing times of patients with defects after excisional surgery, trauma, chronic ulcers and abdominal defects were 11.218 days (95% CI = 6.183-16.253), 11.561 days (95% CI = 7.062-16.060), 15.956 days (95% CI = 11.916-19.996) and 12.853 days (95% CI=9.444-16.227), respectively. The pooled wound healing rates of patients with defects after fasciotomy, excisional surgery, trauma, chronic ulcers and abdominal defects were 93.8% (95% CI=87.1-98.2%), 97.2% (95%CI=92.2-99.7%), 97.0% (95%CI=91.2-99.8%), 99.5% (95%CI=97.6-100%), and 96.8% (95%CI=79.2-100%), respectively. We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds. The pooled median wound healing time of patients with diabetic ulcers was 11.730 days (95% CI = 10.334-13.125). The pooled median wound healing time of patients with open abdomen defects was 48.810 days (95% CI = 35.557–62.063) and the pooled successful healing rate was 68.8% (95% CI = 45.9-88.1%). A total of 1686 patients were included, 265 (15.7%) of whom experienced complications. The most common complication was dehiscence (n = 53, 3.14%).
Conclusions
Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects. However, we must interpret the meta-analysis results with caution considering the limitations of this review. Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.
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Affiliation(s)
- Xirui Tong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Jianyu Lu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Wei Zhang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Siqiao Wang
- Tongji University School of Medicine, Tongji University , Shanghai, 200092 , China
| | - Runzhi Huang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Xianliang Zhang
- Hospital of the 92426 Troops of the Chinese People’s Liberation Army , Tsingtao, 266400 , China
| | - Jie Huang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Yushu Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Shichu Xiao
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Shizhao Ji
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
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18
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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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19
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Rosicka K, Hill M, Wdowski MM. Skin anisotropy: Finding the optimal incision line for volar forearm in males and females. J Mech Behav Biomed Mater 2021; 124:104805. [PMID: 34474321 DOI: 10.1016/j.jmbbm.2021.104805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Proper understanding of skin biomechanics, viscoelasticity and investigation of skin tension vectors is necessary to find optimal incision lines. Great tension across a healing wound after any surgical procedure might lead to forming hypertrophic scars. The aim of the study was to investigate tension lines in volar forearm skin in young males and females, in order to ensure best incision line. METHODS Five biomechanical and viscoelastic parameters were measured using a hand-held myotonometer: Oscillation Frequency [Hz], Dynamic Stiffness [N/m], Logarithmic Decrement of tissue's natural oscillation, Mechanical Stress Relaxation Time [ms], and Creep. Measurements were taken in four different directions; Along Forearm, Across Forearm, Along Langer's Line and Across Langer's Line. RESULTS Significant main effects for direction were found for Oscillation Frequency (p < 0.001, η2 = 0.371) [Hz], Dynamic Stiffness (p < 0.001, η2 = 0.522) [N/m], Logarithmic Decrement (p < 0.001, η2 = 0.083), Mechanical Stress Relaxation Time (p < 0.001, η2 = 0.494) [ms] and Creep (p < 0.001, η2 = 0.480). For each parameter except for logarithmic decrement results obtained Along Langers Line and Across Forearm were significantly different to Across Langers Line and Along Forearm (p < 0.001, d = -2.76 - 2.66). Significant main effects for sex were found for logarithmic decrement Along Forearm (p < 0.001, d = 1.698) and Across Langer's Line (p = 0.021, d = 1.697). CONCLUSIONS Our results suggested that optimal incision line for this age group in males and females could potentially be performed diagonally i.e. Across Langer's Line or parallel i.e. Along Forearm to forearm axis. These directions would provide the lowest tension across a healing wound and possibly minimalize the risk of hypertrophic scarring post incision.
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Affiliation(s)
- K Rosicka
- Department of Biological Sciences, Faculty of Physical Culture in Gorzów Wlkp., Poznań University of Physical Education, Gorzów Wlkp, Poland.
| | - M Hill
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, United Kingdom
| | - M M Wdowski
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, United Kingdom
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20
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Tong Y, Yu S, Guo K, Wang X, Wu Y, Xia Z, Li G, Hu H, Yu M, Zhu Z. First known case of successful pressure ulcer treatment in a lung transplant patient with post-COVID-19 pneumonia. J Wound Care 2021; 30:594-597. [PMID: 34382848 DOI: 10.12968/jowc.2021.30.8.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.
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Affiliation(s)
- Yilan Tong
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sijiong Yu
- Beijing University of Agriculture, Animal Science and Technology College, China
| | - Kaijun Guo
- Beijing University of Agriculture, Animal Science and Technology College, China
| | - Xiangsheng Wang
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Wu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guang Li
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haifeng Hu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mosheng Yu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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21
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Wu Y, Chen L, Mao X, Ru Z, Yu L, Chen M, Wang J, Chen J, Pang Q. Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage-Clinical Outcome of 34 Patients. INT J LOW EXTR WOUND 2021:15347346211032046. [PMID: 34279133 DOI: 10.1177/15347346211032046] [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: 11/15/2022]
Abstract
Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (W/L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (P < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (W/L > 0.5) were more difficult to close than in group B (W/L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.
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Affiliation(s)
- Yaojun Wu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Liang Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinliang Mao
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | | | - Liying Yu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Mimi Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jingnan Wang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiejie Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qingjiang Pang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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22
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Rodriguez-Jiménez P, Russo F, Navarro R, Gallo E, Delgado JY. Modified S-Reinforced Suture in Dermatologic Surgery. A Novel Alternative for Lower Leg Defects. J Cutan Med Surg 2021; 25:652-653. [PMID: 34213974 DOI: 10.1177/12034754211024163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P Rodriguez-Jiménez
- 1651796906 Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - F Russo
- Clinica Privada Algeciras, Cádiz, Spain
| | - R Navarro
- 1651796906 Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - E Gallo
- 1651796906 Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Jiménez Y Delgado
- 1651796906 Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
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23
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Solomonov E, Khalifa M, Rozentsvaig V, Koifman I, Biswas S, Topaz M. Case Report: Delayed Primary Wound Closure After Extensive Abdominal Wall Resection for Infection and Malignancy Using TopClosure®. Front Surg 2021; 8:684513. [PMID: 34095212 PMCID: PMC8173211 DOI: 10.3389/fsurg.2021.684513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 01/31/2023] Open
Abstract
The closure of a massive abdominal wall defect is illustrated using a novel dynamic closure technique - the TopClosure® tension relief system. This system attaches to the abdominal wall immediately after laparotomy and allows for early approximation of the skin, avoiding an open abdomen and the complications associated with this. The technique in this case was employed after extensive resection of the abdominal wall for infected skin metastases of colonic adenocarcinoma and circumvented post-operative ventilation and open abdomen. Early recovery after such extensive surgery is important in terms of patient morbidity and mortality. In this case, primary surgery may not have been an acceptable risk to undertake without the option of Top Closure of the abdomen. We illustrate the technique of abdominal wall closure through a series of images of the procedure.
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Affiliation(s)
| | | | | | | | - Seema Biswas
- Galilee Medical Center, Nahariya, Israel.,IVT Medical Ltd., Ra'anana, Israel
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24
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Wu Y, Chen L, Wu S, Yu L, Chen M, Wang J, Chen J, Pang Q. Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds. J Orthop Surg Res 2021; 16:258. [PMID: 33853638 PMCID: PMC8045371 DOI: 10.1186/s13018-021-02405-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023] Open
Abstract
The management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety. A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2). The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study. In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.
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Affiliation(s)
- Yaojun Wu
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Liang Chen
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China.
| | - Shaokun Wu
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Liying Yu
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Mimi Chen
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Jingnan Wang
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Jiejie Chen
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
| | - Qingjiang Pang
- Department of Orthopedics, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), No. 41 Northwest Street, Ningbo, 315010, Zhejiang, China
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25
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Abstract
ABSTRACT Pediatric scalp defects may be challenging, due to their variant tension level and specific etiologies. Tissue characteristics and pre- and post-management considerations may pose difficulties to reconstruction in the pediatric patient. Primary closure is the preferred surgical technique but is not always possible. Various techniques have been described for facilitating primary wound closure, by reducing tension from the skin wound margins. The authors use a tension-relief system in some challenging scalp wounds when simple primary closure cannot be achieved. This enables primary closure without tension on the surgical margins, and may thus preclude the need for other closure techniques such as tissue-expanders, grafts, and flaps. The authors describe our use of a tension-relief system in 21 pediatric patients treated during 2017-2020, for congenital deformities, vascular malformations and other skin lesions, traumatic wounds, burn scars, and complicated surgical wounds with and without hardware exposure. A tension-relief system is a prompt, simple-to-use, safe, and low-cost surgical solution that offers several advantages over other techniques when tension-free primary intention closure is not possible. These benefits include less extensive surgery, fewer surgeries and associated anesthesia, shorter treatment period and hospitalization, better scarring, lower distress and burden to patients and their families, better pain-control, the absence of donor-site with its comorbidities, and less bleeding and risk of damaging adjacent structures. Based on our experience and the system characteristics detailed, the authors recommend using the described technique, which is convenient, accessible, and reliable, to close challenging scalp wounds in pediatric patients.
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26
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Wang L, Wang C, Chen H, Chen Y, Li J, Xiao L, Zhu D, Yang C. The Combined Use of a Non-Invasive Skin-Stretching Device and the Negative-Pressure Wound Therapy Technique in the Treatment of Postoperative Diabetic Foot. Diabetes Metab Syndr Obes 2021; 14:3523-3532. [PMID: 34385827 PMCID: PMC8352599 DOI: 10.2147/dmso.s322757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The present study explored the effectiveness of using a non-invasive skin-stretching device (NSSD) combined with negative-pressure wound therapy (NPWT) for the postoperative wound repair of diabetic foot (DF) gangrene. METHODS The treatment group in this study involved 42 patients with Wagner grade 3-4 DF and undergone concomitant toe amputation or debridement, who were given NPWT combined with the use of a NSSD. The control group comprised 42 patients with similar trauma areas (±20%) that were matched at a ratio of 1:1. Following surgery, these patients received NPWT combined with the use of conventional dressings. A comparison was made of the postoperative wound healing rates and wound healing times of the two groups, with Kaplan-Meier survival analysis being used to compare the healing rate over time. RESULTS The three-month wound healing rate was higher in the treatment group than in the control group (38 of 42 [90.5%] vs 25 of 42 [59.5%], p = 0.002), and the wound healing time was shorter in the treatment group (44 days [95% CI 40.0-48.0]) than that in the control group (76 days [95% CI 63.0-89.0], p = 0.000). Taking the end of the final NPWT as the starting point, the comparison of wound healing time revealed that this period was shorter in the treatment group than that in the control group and the difference was statistically significant (11 days [95% CI 9.0-13.0] vs 42 days [95% CI 23.0-ND], p = 0.000). CONCLUSION The use of the NPWT technique combined with a NSSD can shorten the wound healing time and improve the wound healing rate of DF gangrene patients during the postoperative wound repair period.
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Affiliation(s)
- Liangchen Wang
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Chenrui Wang
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Hongmei Chen
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Ying Chen
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Juan Li
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Li Xiao
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Di Zhu
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
| | - Caizhe Yang
- Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of China
- Correspondence: Caizhe Yang Department of Endocrinology, Air Force Medical Center, PLA, Beijing, 100142, People’s Republic of ChinaTel/Fax +86 1066928242 Email
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27
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Freund MR, Reissman P, Spira RM, Topaz M. Innovative approach to open abdomen: converting an enteroatmospheric fistula into an easily manageable stoma. BMJ Case Rep 2020; 13:13/8/e234207. [PMID: 32847870 PMCID: PMC7451951 DOI: 10.1136/bcr-2019-234207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 52-year-old super morbidly obese patient underwent elective laparoscopic conversion of a failed silastic ring vertical gastroplasty to a Roux-en-Y gastric bypass. Following surgery, she developed an anastomotic leak which required emergent laparotomy. The patient then suffered from a complex postoperative course during which she developed an intestinal fistula which freely drained into the wound and gradually led to its complete dehiscence. Her course was further complicated by the surfacing of an enteroatmospheric fistula. This devastating complication was managed by employing the TopClosure Tension Relief system. Using the inverse maturation technique, further described in this report, we were able to progressively approximate and invert the edges of the skin around the enteroatmospheric fistula, thereby facilitating its conversion to an easily manageable stoma. Using this technique, we were able to achieve delayed primary wound closure of a grade 4 open abdomen complicated by an enteroatmospheric fistula in just under 5 weeks' time.
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Affiliation(s)
- Michael Ron Freund
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Ram M Spira
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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28
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Topaz M, Gurevich M, Ashkenazi I. Simplified management of a giant forehead congenital nevus allows for early reconstruction. BMJ Case Rep 2020; 13:13/7/e234164. [PMID: 32665278 PMCID: PMC7359177 DOI: 10.1136/bcr-2019-234164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We report simplified surgical management of giant congenital forehead nevus that customarily requires the use of tissue expander for complete excision. Commencing treatment at the age of 3 months, the TopClosure tension relief system (TRS) was applied as an external tissue expander allowing preoperative skin stretching by mechanical creep. This was followed by partial excision of the nevus. Intraoperative stress-relaxation allowed further expansion of the skin. Postoperative wound closure was secured with the aid of the TRS. Repeated, six simple staged excisions of the forehead lesion and a minor skin graft to the eyelid part, allowed for delayed primary closure of the entire lesion by the age of 2. This simple alternative approach, which allows the early start and early conclusion of the reconstructive process, should be considered as the primary option in the treatment of these patients.
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Affiliation(s)
| | - Michael Gurevich
- Transplant Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Itamar Ashkenazi
- Surgery Department, Rambam Health Care Campus, Haifa, Haifa, Israel
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29
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Abstract
Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.
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Affiliation(s)
- André Oliveira
- Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Simões
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Ascenso
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Pinto Reis
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Sciences, Biophysics and Biomedical Engineering, IBEB, Universidade de Lisboa, Lisboa, Portugal
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30
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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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31
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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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32
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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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33
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Ashkenazi I, Olsha O, Topaz M. Relaxation systems of the skin for the closure of large mammary defects. Cir Esp 2019; 98:154-157. [PMID: 31718783 DOI: 10.1016/j.ciresp.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 01/31/2023]
Abstract
In mammary tumors that are large relative to breast-size, complex reconstructive methods are required. We describe an alternative system of closure. In circumstances such as this, primary closure of this skin defect may be enabled by stress relaxation of the skin and the use of a tension-relief system. Tension-relief systems secures immediate primary closure of large skin defects in patients with large for breast-size tumors by placing the tension away from the skin edges. This enables early skin closure and rapid mobilization with good functionality. Optimal healing facilitates postoperative radiotherapy on time without reconstruction failure.
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Affiliation(s)
| | - Oded Olsha
- Centro Médico Shaare Zedek, Jerusalén, Israel
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34
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Zhang F, Gu Y, Wu L. Skin-stretching device promotes the treatment effect of vacuum sealing drainage technique on phases III and IV stress-induced injuries in aged patients with chronic critical illness: A retrospective study of 70 patients. Medicine (Baltimore) 2019; 98:e18027. [PMID: 31764820 PMCID: PMC6882589 DOI: 10.1097/md.0000000000018027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stress-induced injury is a common complication associated with patients with chronic critical illness (CCI). Skin-stretching device (SSD) and vacuum sealing drainage (VSD) technique are 2 approaches that can facilitate wound healing.In the present study, the effect of the concatenated application of the 2 techniques on the phases III and IV stress-induced injuries in aged patients with CCI was assessed. About 70 patients with CCI with stress-induced injuries were selected from February 2015 to October 2017. The treatment outcomes of the combined method and VSD method were assessed by comparing their clinicopathologic parameters.The results showed that the combined treatment shortened the average healing duration of wounds. Moreover, the total area of pressure sores, incidence of bleeding, bacteria amount, 28-day cure rate, peripheral C-reactive protein (CRP) level, and the hospitalization duration were all significantly improved in patients treated with SSD and VSD. The overall effective rate (97.14%) of patients treated with VSD and SSD was significantly higher than that (77.14%) in patients treated with VSD.The present study showed that the combined application of VSD and SSD improved the treatment outcomes of phases III and IV stress-induced injuries in aged patients with CCI.
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Affiliation(s)
- Fulian Zhang
- Department of Intensive Care Unit, Hangzhou First People's Hospital
- Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou, China
| | - Yuecheng Gu
- Department of Intensive Care Unit, Hangzhou First People's Hospital
- Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou, China
| | - Linjun Wu
- Department of Intensive Care Unit, Hangzhou First People's Hospital
- Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou, China
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35
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Lear W, Blattner CM, Mustoe TA, Kruzic JJ. In vivo stress relaxation of human scalp. J Mech Behav Biomed Mater 2019; 97:85-89. [PMID: 31102983 DOI: 10.1016/j.jmbbm.2019.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Conduct a first in vivo study on the large deformation stress relaxation behavior of the human scalp. METHODS This study was conducted during Mohs micrographic surgery of the scalp of 14 patients aged 59-90 with wounds initially ranging from 9 to 41 mm wide. The initial wound diameter was measured under zero applied force. Then, the force required to close each wound using a single size 1 nylon suture and a SUTUREGARD suture retention device was measured, after which the suture was then locked in the retention device at fixed displacement. At time points of 300 s, 600 s, and 1800 s, the suture retention device was released, and the wound opening was again recorded at zero force, and the force required to close the wound was recorded. RESULTS The average wound closure force relaxed by 44% and 65% after 300 s and 1800 s, respectively. Average wound width decreased 30% and 42%, after 300 s and 1800 s, respectively, due to creep deformation. Furthermore, all wounds relaxed to be below 15 N of closure force after 600 s, which is considered the maximum clinically acceptable force. A relaxation time of ∼270 s and a threshold force for creep of ∼5 N was found. SIGNIFICANCE Results of this study provide the first quantitative clinical guidance for efficient scalp closure of large wounds by creep deformation and stress relaxation. Furthermore, the methodology developed here can be used as a basis for future in vivo studies of the stress relaxation and creep deformation of human scalp, which in turn can provide data for the development and validation of constitutive models for scalp deformation.
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Affiliation(s)
- William Lear
- Departments of Dermatology and Dermatologic Surgery, Silver Falls Dermatology, Corvallis, OR, 97330, USA
| | - Collin M Blattner
- Departments of Dermatology and Dermatologic Surgery, Silver Falls Dermatology, Corvallis, OR, 97330, USA
| | - Thomas A Mustoe
- Clinical Faculty, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jamie J Kruzic
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Sydney, NSW, 2052, Australia.
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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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Yontar Y, Tatar S, Aydin A, Coruh A. Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires. Plast Surg (Oakv) 2019; 27:29-37. [PMID: 30854359 DOI: 10.1177/2292550317750147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.
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Affiliation(s)
- Yalcin Yontar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Sedat Tatar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Koç American Hospital, Istanbul, Turkey
| | - Ahmet Aydin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Atilla Coruh
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
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Li J, Shi JB, Hong P, Wang YS, Ze HR, Lee RJ, Tang X. Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects. Medicine (Baltimore) 2019; 98:e14205. [PMID: 30681595 PMCID: PMC6358379 DOI: 10.1097/md.0000000000014205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Traumatic hemipelvectomy is a rare but lethal catastrophic injury. PATIENT CONCERNS A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects. DIAGNOSIS Traumatic hemipelvectomy. INTERVENTIONS Complete amputation was performed and three kinds of surgical techniques including regulated negative pressure-assisted wound therapy (RNPT), TopClosure device, and Ilizarov technique were jointly utilized to secure closure in the further revisions of the soft tissue injury and reconstruct reconstructive surgery. OUTCOMES Six months after hospital discharge, the patient was able to ambulate with a single limb and a prosthesis and she is independent in many activities of daily living currently. LESSONS We report this case to share experience with other clinicians in the management of this deadly extensive defects after traumatic hemipelvectomy in patients.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Bao Shi
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Shang Wang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hao Ren Ze
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rushyuan Jay Lee
- Department of Orthopaedic Surgery, Bloomberg Children's Hospital, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Zhang L, Wang X, Chen Y, Chen J, Guo Z. [Discussion on dealing skills of complex soft tissue problems in osteomyelitis treated by Ilizarov technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1286-1291. [PMID: 30600666 DOI: 10.7507/1002-1892.201805055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective To discuss skills for the treatment of complex soft tissue problems in osteomyelitis using Ilizarov techniques. Methods The clinical data of 31 patients with complex soft tissue problems during the treatment of osteomyelitis with Ilizarov technique between January 2015 and June 2017 were retrospectively analyzed. There were 23 males and 8 females, with an age of 14-67 years (mean, 37.8 years). All the patients were post-traumatic chronic osteomyelitis, the disease duration was 12 days to 16 months (mean, 6.3 months). They went through 2-8 times surgeries (mean, 3.8 times). There were 29 cases of soft tissue insertion after bone grafting; 1 case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect; 1 case of the open tibial fracture postoperative infection, the skin defect of infection was more than that of bone defect. The soft tissue defect area was 4.5 cm×4.0 cm to 16.5 cm×8.5 cm. Soft tissue depression and insertion was corrected by subcutaneous insertion of Kirschner wire after slow elastic retraction. Soft tissue defects were gradually resolved through slow traction. Results All patients were followed up 6-24 months (mean, 11.5 months). All wounds healed by first intention, and skin graft and flap repair were not performed in the two stage. One case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect was treated with slow skin traction, no secondary suture was performed; no skin ulceration was found after walking for 3 months, and the feeling was slightly lower than normal. One case of soft tissue transverse traction wound completely covered, with no bone exposure and no obvious pigmentation of local soft tissue, the feeling was slightly lower than normal, the skin elasticity was worse than normal, and the color, temperature had no obvious abnormalities. There was no severe needle eye reactions in 29 patients with skin depressions corrected by Kirschner wire. Six cases of Kirschner wire showed elastic retraction and lacerate skin; 1 case of plantar skin traction had 2 times of exudation of the needle eye and local skin reddish phenomenon; the symptoms relieved when the traction needle was changed once, the traction was stopped for 1 week, the dressing was changed and antibiotics were used once. One patient with transverse traction had 3 times of pin-eye infection, and the treatment was completed after adjusting the traction device and symptomatic treatment. Conclusion For most of the complex soft tissue problems in osteomyelitis, early and effective intervention with Ilizarov technique can be easily, economically, and effectively solved, which provides a new way for clinical treatment.
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Affiliation(s)
- Lei Zhang
- No.1 Department of Osteomyelitis, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002, P.R.China
| | - Xinwei Wang
- No.1 Department of Osteomyelitis, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002,
| | - Yusheng Chen
- Department of VIP, the Second Hospital Affiliated To Henan University of Science and Technology, Luoyang Henan, 471000, P.R.China
| | - Jiangfei Chen
- No.1 Department of Osteomyelitis, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002, P.R.China
| | - Zairan Guo
- No.1 Department of Osteomyelitis, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002, P.R.China
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Blattner CM, Perry B, Young J, Lear W. The use of a suture retention device to enhance tissue expansion and healing in the repair of scalp and lower leg wounds. JAAD Case Rep 2018; 4:655-661. [PMID: 30109254 PMCID: PMC6089068 DOI: 10.1016/j.jdcr.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Benjamin Perry
- Department of Dermatology, Silver Falls Dermatology, Salem, Oregon.,Department of Dermatologic Surgery, Silver Falls Dermatology, Salem, Oregon
| | - John Young
- Department of Dermatology, Silver Falls Dermatology, Salem, Oregon
| | - William Lear
- Department of Dermatology, Silver Falls Dermatology, Salem, Oregon.,Department of Dermatologic Surgery, Silver Falls Dermatology, Salem, Oregon
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Karkos CD, Papoutsis I, Giagtzidis IT, Pliatsios I, Mitka MA, Papazoglou KO, Kambaroudis AG. Management of Postfasciotomy Wounds and Skin Defects Following Complex Vascular Trauma to the Extremities Using the External Tissue Extender System. INT J LOW EXTR WOUND 2018; 17:113-119. [DOI: 10.1177/1534734618765343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Management of large postfasciotomy wounds and/or skin and soft tissue defects after major vascular trauma to the extremities can be challenging. The External Tissue Extender (Blomqvist; ETE), a skin-stretching device, which consists of silicone tapes and plastic stoppers, approximates wound margins and facilitates delayed primary closure. We describe our experience with the use of ETE in 5 patients (4 males) with a total of 8 wounds (7 postfasciotomy, 1 soft tissue defect) over the past 12 years. The mean patient age was 32 (range 17-61) years. The wounds involved the lower limb in 3 patients and the upper limb in 2, whereas the injured arteries were the popliteal in 3, the axillary in 1, and the brachial in 1. The mean wound length was 24 cm (range 9-37 cm), and the mean number of ETE silicone tapes used per wound was 13 (range 5-19). The median duration of ETE therapy was 7 days (range 4-7). ETE therapy resulted in sufficient wound approximation to allow complete closure with conventional suturing in 7 out of the 8 wounds. Of these, one developed infection that required drainage, debridement, and resuturing. All wounds achieved satisfactory healing status and all limbs had been salvaged. In conclusion, the ETE is a useful, easy-to-use, and simple adjunct that may facilitate delayed primary closure of large postfasciotomy wounds or extensive skin and soft tissue defects following complex vascular trauma to the extremities.
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Zhu Z, Zhao Y, Yu M, Topaz M. A skin stretch system for the immediately closing of the large skin defects of the anterior chest wall following large keloid excision. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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43
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Non-surgical wound closure—a simple inexpensive technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Arain AR, Cole K, Sullivan C, Banerjee S, Kazley J, Uhl RL. Tissue expanders with a focus on extremity reconstruction. Expert Rev Med Devices 2018; 15:145-155. [PMID: 29322847 DOI: 10.1080/17434440.2018.1426457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Acute traumatic or surgical wounds that cannot be primarily closed often cause substantial morbidity and mortality. This often leads to increased costs from higher material expenses, more involved nursing care, and longer hospital stays. Advancements in soft tissue expansion has made it a popular alternative to facilitate early closure without the need for more complicated plastic surgical procedures. AREAS COVERED In this review, we briefly elaborate on the history and biomechanics of tissue expansion and provide comprehensive descriptions of traditional internal tissue expanders and a variety of contemporary external tissue expanders. We describe their uses, advantages, disadvantages, and clinical outcomes. The majority of articles reviewed include case series with level IV evidence. Outcome data was collected for studies after 1990 using PubMed database. EXPERT COMMENTARY An overall reduction in cost, time-to-wound closure, hospital length-of-stay, and infection rate may be expected with most tissue expanders. However, further studies comparing outcomes and cost-effectiveness of various expanders may be beneficial. Surgeons should be aware of the wide array of tissue expanders that are commercially available to individualize treatment based on thorough understanding of their advantages and disadvantages to optimize outcomes. We predict the use of external expanders to increase in the future and the need for more invasive procedures such as flaps to decrease.
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Affiliation(s)
- Abdul R Arain
- a Resident, Division of Orthopaedic Surgery , Albany Medical Center , Albany , NY, USA
| | - Keegan Cole
- a Resident, Division of Orthopaedic Surgery , Albany Medical Center , Albany , NY, USA
| | - Christopher Sullivan
- b Medical Student , Albany Medical College, Albany Medical Center , Albany , NY, USA
| | - Samik Banerjee
- a Resident, Division of Orthopaedic Surgery , Albany Medical Center , Albany , NY, USA
| | - Jillian Kazley
- a Resident, Division of Orthopaedic Surgery , Albany Medical Center , Albany , NY, USA
| | - Richard L Uhl
- c Chairman, Division of Orthopaedic Surgery , Albany Medical Center , Albany , NY, USA
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Choke A, Goh TL, Kang GCW, Tan BK. Delayed primary closure of extensive wounds using the TopClosure system and topical negative pressure therapy. J Plast Reconstr Aesthet Surg 2017; 70:968-970. [DOI: 10.1016/j.bjps.2017.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 12/11/2022]
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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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Huahui Z, Dan X, Hongfei J, Hang H, Chunmao H, Haitao R, Jianxin Y, Zhiping T. Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study. Plast Surg (Oakv) 2016; 24:177-182. [PMID: 28439506 DOI: 10.4172/plastic-surgery.1000972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.
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Affiliation(s)
- Zhang Huahui
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Xue Dan
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Jiang Hongfei
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Hu Hang
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Han Chunmao
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Ren Haitao
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Yu Jianxin
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Tao Zhiping
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
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Huahui Z, Dan X, Hongfei J, Hang H, Chunmao H, Haitao R, Jianxin Y, Zhiping T. Evaluation of a new tension relief system for securing wound closure: a single-centre, Chinese cohort study. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. Objective To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. Methods From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. Results Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. Discussion There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. Conclusions The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.
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Affiliation(s)
- Zhang Huahui
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine
| | - Xue Dan
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine
| | - Jiang Hongfei
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, College of Medicine
| | - Hu Hang
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Han Chunmao
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Ren Haitao
- Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, People's Republic of China
| | - Yu Jianxin
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine
| | - Tao Zhiping
- Department of Plastic Surgery, Second Affiliated Hospital, College of Medicine
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Ratnam BV. A simple external tissue expansion technique based on viscoelastic properties of skin to attain direct closure of a large scalp defect: A case report. Indian J Plast Surg 2016; 48:309-12. [PMID: 26933288 PMCID: PMC4750267 DOI: 10.4103/0970-0358.173137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Direct closure of large scalp defects is not an easy task. Complicated flap designs or staged surgeries over a period of 6 months are often required. A case of a large scalp defect that was closed directly in 3 months by applying a simple external tissue expansion technique is presented in this report. Patient Profile: A 28-year-old male patient presented with a painful swelling of about 13 cm × 14 cm, on frontoparietal scalp. A biopsy done elsewhere reported it to be a neurofibroma. He sought tumour excision and scalp defect coverage by hair-bearing scalp in a period of less than 5 months. Materials and Methods: The tumour was excised and the adjacent scalp was gradually expanded with the help of an external fixator. The patient had immediate pain relief after excision. The goal of repairing scalp defect and replacing it with hairy scalp was achieved in 3 months. Conclusion: The mechanical device required for this technique is relatively easily accessible. It is not difficult to achieve desirable outcomes, and the same can be applied to large wounds on other areas.
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Katzengold R, Topaz M, Gefen A. Tissue loads applied by a novel medical device for closing large wounds. J Tissue Viability 2016; 25:32-40. [DOI: 10.1016/j.jtv.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/27/2015] [Accepted: 12/12/2015] [Indexed: 12/27/2022]
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