1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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]
|
5
|
Abstract
BACKGROUND Numerous conventional wound reconstruction methods, such as wound undermining with direct suture, skin graft, and flap surgery, can be used to treat large wounds. The adequate undermining of the skin flaps of a wound is a commonly used technique for achieving the closure of large tension wounds; however, the use of tension to approximate and suture the skin flaps can cause ischemic marginal necrosis. The purpose of this study is to use elastic rubber bands to relieve the tension of direct wound closure for simultaneously minimizing the risks of wound dehiscence and wound edge ischemia that lead to necrosis. MATERIALS AND METHODS This retrospective study was conducted to evaluate our clinical experiences with 22 large wounds, which involved performing primary closures under a considerable amount of tension by using elastic rubber bands in a skin-stretching technique after a wide undermining procedure. Assessment of the results entailed complete wound healing and related complications. RESULTS All 22 wounds in our study showed fair to good results except for one. The mean success rate was approximately 95.45%. CONCLUSIONS The simple skin-stretching design enabled tension-free skin closure, which pulled the bilateral undermining skin flaps as bilateral fasciocutaneous advancement flaps. The skin-stretching technique was generally successful.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Tsioli V, Papazoglou LG, Papaioannou N, Psalla D, Savvas I, Pavlidis L, Karayannopoulpou M. Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs. J Vet Sci 2014; 16:99-106. [PMID: 25269717 PMCID: PMC4367155 DOI: 10.4142/jvs.2015.16.1.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/26/2014] [Indexed: 12/03/2022] Open
Abstract
Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.
Collapse
Affiliation(s)
- Vassiliki Tsioli
- Department of Surgery, Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100,
| | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Technique for Use of External Tissue Expansion for Reconstruction of Head and Face Defects. Dermatol Surg 2007. [DOI: 10.1097/00042728-200707000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Ger R, Schessel ES. Technique for use of external tissue expansion for reconstruction of head and face defects. Dermatol Surg 2007; 33:864-71. [PMID: 17598857 DOI: 10.1111/j.1524-4725.2007.33185.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ralph Ger
- Albert Einstein College of Medicine, New York, NY, USA.
| | | |
Collapse
|
11
|
Melis P, van Noorden CJF, van der Horst CMAM. Long-Term Results of Wounds Closed under a Significant Amount of Tension. Plast Reconstr Surg 2006; 117:259-65. [PMID: 16404277 DOI: 10.1097/01.prs.0000195080.65662.f5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors present the long-term follow-up of scars on various locations up to 7 years postoperatively, after closure of large skin defects with the use of a skin-stretching device. METHODS In a prospective, nonrandomized study of 30 patients whose initial wound could not be closed primarily without using a significant amount of tension, a complete follow-up of 24 cases was possible. Patients were observed preoperatively, postoperatively, and at long-term follow-up (mean, 7 years) for wound control and scar evaluation. RESULTS In 28 cases (93 percent), successful closure of a large defect was achieved. In the other two cases, a split-thickness skin graft was needed for wound closure. With respect to long-term scar formation after 7 years (24 cases), scarring was observed mainly on the scalp (average, 56 percent), back (average, 52 percent), and shoulder (average, 53 percent). On the extremities, including thigh and groin, there was significantly less scarring (p = 0.0004; average, 10 percent). Three weeks after the operation, 23 percent of the total scar formation had already occurred, whereas 57 percent occurred by 3 months postoperatively and 83 percent occurred by 6 months postoperatively. CONCLUSION This study demonstrates the considerable difference in scar formation among scalp, back, and shoulder defects compared with those on the extremities, groin, and thigh.
Collapse
Affiliation(s)
- Paris Melis
- Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
| | | | | |
Collapse
|
12
|
Schessel ES, Lombardi CM, Dennis LN. External constant tension expansion of soft tissue for the treatment of ulceration of the foot and ankle. J Foot Ankle Surg 2000; 39:321-8. [PMID: 11055023 DOI: 10.1016/s1067-2516(00)80048-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A clinical series of the management of 74 lesions in the foot and ankle region in 67 patients using a constant tension-approximating device is presented. The technical aspects of this methodology are detailed as they have been developed over the past 4 years. The indications, contraindications, and the requirements to obtain a successful result are discussed. The differences, as well as the possible advantages over other mechanical devices used in wound management, are discussed. The incidence and degree of complications are considered to be minimal when compared to both flap procedures and internal expansion technologies.
Collapse
|
13
|
Melis P, Bos KE, Horenblas S. Primary skin closure of a large groin defect after inguinal lymphadenectomy for penile cancer using a skin stretching device. J Urol 1998; 159:185-7. [PMID: 9400468 DOI: 10.1016/s0022-5347(01)64052-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We describe a method of primary closure of a large skin defect. MATERIALS AND METHODS A 44-year-old man was treated for penile cancer. After left inguinal lymphadenectomy a large skin defect in the groin remained that could not be closed primarily. Allowing skin to stretch beyond its inherent extensibility with a skin stretching system (Sure-Closure) the wound edges were closed without tension. RESULTS Primary closure of a large skin defect was possible after cyclic stretching and relaxation of the skin with a skin stretching device. CONCLUSIONS Large skin defects can be closed primarily using a skin stretching device. The primary advantage of the procedure are its simplicity and avoidance of the need for more complicated reconstructive surgery.
Collapse
Affiliation(s)
- P Melis
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
| | | | | |
Collapse
|