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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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Shen Z, Chen S, Duan Y, Yu J, Pan D, Dong J, Wang S, Li Q, Xiao Y, Yuan X. Application of Adjustable Skin Stretchers in Repairing Wound-Related Defects. Clin Cosmet Investig Dermatol 2023; 16:2409-2417. [PMID: 37694193 PMCID: PMC10492556 DOI: 10.2147/ccid.s411870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
Objective To explore the application value of adjustable skin stretchers for repairing skin wound defects. Methods Twenty patients with skin defects were included in this study. The largest defect was measured to be 45.4 cm × 13.3 cm (length × width) and the smallest one was 4.4 cm × 3.2 cm (length × width). All patients were subjected to adjustable skin stretchers and the short- and long-term clinical efficacy was evaluated. Results The wounds of all enrolled patients were healed completely except for one patient with a dorsal foot infection (the patient requested to return to the local county hospital for further treatment), with a total satisfaction of 100%. Postoperative 3-month follow-up showed scar formation, a little local hyperpigmentation, normal skin elasticity, and intact organs of involved cases, thus signifying the significant impact of adjacent joint activities. Conclusion Adjustable skin stretchers can accurately control the tension on wound margins, breaking the limitation of previous stretchers to provide objective quantitative indicators for clinical application. These stretchers are characterized by high use-value and are worth promoting.
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Affiliation(s)
- Zhimin Shen
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Shiping Chen
- Department of Orthopedics, The No.1 People’s Hospital of Qingzhen, Qingzhen City, People’s Republic of China
| | - Yiqiang Duan
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Juan Yu
- The Affiliated Stomatological Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Dayang Pan
- The 4th People’s Hospital of Guiyang, Guiyang City, People’s Republic of China
| | - Jiaxin Dong
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Shanglong Wang
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Qizhe Li
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Yinlong Xiao
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of China
| | - Xun Yuan
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guiyang City, People’s Republic of 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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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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May BL, Googe B, Durr S, Googe A, Arnold P, Hoppe I, McIntyre B. Utility of a Continuous External Tissue Expander in Complex Pediatric Wound Reconstruction. EPLASTY 2022; 22:e10. [PMID: 35611153 PMCID: PMC9108423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Soft tissue reconstruction following traumatic injury can be devastating. Reconstructive treatment modalities can prove to be complex. DermaClose (Synovis Micro Companies Alliance, Inc) is a relatively novel wound closure device that has gained popularity for continuous external tissue expansion (CETE). METHODS A single-institution case series of 3 traumatic pediatric soft tissue injuries in which DermaClose was used for soft tissue reconstruction as an alternative to free tissue transfer was presented. A review of the literature to identify similar reported cases was also conducted. RESULTS The authors report their success with the use of this continuous external tissue expander in the management of pediatric soft tissue injuries. Open tibial fractures were sustained by 2 patients, and 1 patient suffered an avulsion injury to the scalp; sequential DermaClose application was successfully utilized to achieve wound closure in all cases. CONCLUSIONS The minimal amount of data currently available in the literature that document the use of this continuous external tissue expander in pediatric patients suggest that its safety and efficacy are inadequately investigated in this population. The cases included in this report suggest DermaClose may be an alternative to traditional methods for complex soft tissue closure in pediatric patients. For larger wounds, repeat applications with sequential closure should be expected and is described in an algorithm within this report.
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Affiliation(s)
- Bobby L. May
- Duke University Hospital, Durham, North Carolina
| | - Ben Googe
- University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, Mississippi
| | - Somer Durr
- University of Mississippi School of Medicine, Jackson, Mississippi
| | - Amber Googe
- University of Mississippi Medical Center, Division of Pediatrics, Grenada, Mississippi
| | - Peter Arnold
- University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, Mississippi
| | - Ian Hoppe
- University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, Mississippi
| | - Ben McIntyre
- University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, Mississippi
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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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Chan PYW, Colon AF, Clune J, Shah A. External Tissue Expansion in Complex Extremity Reconstruction. J Hand Surg Am 2021; 46:1094-1103. [PMID: 34688502 DOI: 10.1016/j.jhsa.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/30/2021] [Accepted: 07/23/2021] [Indexed: 02/02/2023]
Abstract
Skin grafting and flap-based reconstruction have been the conventional treatments for complex extremity wounds. However, these methods can be associated with relatively high complication rates and involve increasing levels of complexity. External tissue expansion has recently emerged as an attractive alternative to its conventional counterparts. It is a technically simple and low-morbidity technique for complex wound reconstruction. This article provides a review of internal and external tissue expansion with a focus on the evolution, indications, and recent successes of external expansion for soft tissue coverage.
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Affiliation(s)
- Peter Y W Chan
- The Center for Hand and Upper Extremity Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ
| | - Anthony F Colon
- Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - James Clune
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT
| | - Ajul Shah
- The Center for Hand and Upper Extremity Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ.
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Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3723. [PMID: 34476148 PMCID: PMC8395595 DOI: 10.1097/gox.0000000000003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Both internal and external tissue expanders take advantage of the innate adaptive mechanisms the skin exerts in response to mechanical tension, known as the stress-relaxation phenomenon. Internal tissue expander use is time-consuming and can be complicated by infection and extrusion. In this case series, continuous external tissue expanders used to manage large pediatric wounds were assessed. Fourteen patients (ages: 4 days to 17 years) with large wounds underwent continuous external tissue expansion intraoperatively. The success of wound closure was assessed. In addition, the size of the patient’s wounds, duration of device application, and postoperative complications were evaluated. The continuous external tissue expander was applied to wound sizes ranging from 14.7 to 560 cm2 for 5 to 10 days until the wound was amenable for direct closure. In 11 of the 14 patients, delayed primary closure was achieved. The device significantly reduced the wound sizes of the remaining three cases (average 80% size reduction). There was no incidence of wound dehiscence or infection. This case series demonstrates the benefit of the continuous external tissue expansion in managing pediatric wounds that would not otherwise be amenable to primary closure. The method allows for timely closure with limited risk of infection or extrusion, and should be in the armamentarium of reconstructive plastic surgeons.
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9
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Wu Q, Shao Z, Li Y, Rai S, Cui M, Yang Y, Wang B. A novel skin-stretching device for closing large skin-soft tissue defects after soft tissue sarcoma resection. World J Surg Oncol 2020; 18:247. [PMID: 32943050 PMCID: PMC7499963 DOI: 10.1186/s12957-020-02022-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/08/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Closure of large skin-soft tissue defects following soft tissue sarcoma (STS) resection has been a great challenge. The objective of this study was to evaluate the effectiveness of a novel, simple, and cheap skin-stretching device (bidirectional regulation-hook skin closure system, BHS) for closing large skin-soft tissue defects resulting from the removal of STS and the complications associated with the use of the BHS. METHODS From January 2017 to September 2018, 25 patients with STS underwent BHS therapy after tumor resection. BHS was used for two main clinical applications: securing wound closure after high-tension suture closure and delayed wound closure. We described a detailed reconstruction procedure regarding this therapy. Wound closure and complications associated with BHS therapy were recorded. We also analyzed tumor recurrence and metastases. RESULTS All patients were observed for 16-36 months with an average follow-up of 25.6 months. During the follow-up period, no significant functional restriction was observed and the final scar was aesthetically acceptable. Superficial wound infection occurred in six patients, wound edge ischemia in two patients, and small skin tears in two patients. Two patients developed pulmonary metastasis, two patients had a local recurrence, and one patient died of pulmonary metastasis. CONCLUSIONS BHS therapy can effectively close large skin-soft tissue defects following STS resection and obtain acceptable functional results, without severe complications. However, larger studies are required to further evaluate the effectiveness, indications, and complications of BHS therapy.
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Affiliation(s)
- Qiang Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yubin Li
- Department of Orthopedics, Linqing City people's Hospital, Linqing, 252600, Shandong, China
| | - Saroj Rai
- National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Min Cui
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ying Yang
- Department of Operation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Baichuan Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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MacKay BJ, Dardano AN, Klapper AM, Parekh SG, Soliman MQ, Valerio IL. Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review. Adv Wound Care (New Rochelle) 2020; 9:525-538. [PMID: 32941124 PMCID: PMC7522632 DOI: 10.1089/wound.2019.1112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Significance: Continuous external tissue expansion (CETE) is a versatile tool in soft tissue injury management, and could be an addition to the traditional reconstructive ladder. Recent Advances: This critical review discusses the principles and application of CETE, covering a company-sponsored consensus meeting on this emerging technology and highlighting the DermaClose® (Synovis Micro Companies Alliance, Inc., Birmingham, AL) device's unique approach to soft tissue injury management. There is clinical evidence to support the use of CETE in the management of a number of wound types, including fasciotomy, trauma, amputation, and flap donor sites. The device can be applied to open wounds, potentially avoiding the need for a skin graft or other more complex or invasive reconstruction options. DermaClose applies constant tension without restricting blood flow and does not require repeated tightening. Critical Issues: CETE is becoming more widely used by surgeons of different specialties, and numerous reports describing its efficacy and safety in wound management have been published. Surgeons using CETE must follow the correct technique and select patients carefully to achieve optimal outcomes. However, there is no single source of information or consensus recommendations regarding CETE application. Future Directions: Prospective evidence on the efficacy and safety of CETE in clinical practice is required to communicate the best techniques and share important experiences. This will help to solidify its place in the reconstructive ladder as a valuable additional option for surgeons.
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Affiliation(s)
- Brendan J. MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
- Department of Orthopaedic Surgery, University Medical Center, Lubbock, Texas
| | - Anthony N. Dardano
- Department of Plastic and Reconstructive Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Andrew M. Klapper
- Department of Plastic and Reconstructive Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Selene G. Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina
- Fuqua Business School, Duke University, Durham, North Carolina
| | - Mohsin Q. Soliman
- Overland Park General and Bariatric Surgery, HCA Physician Services, Overland Park, Kansas
| | - Ian L. Valerio
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Abstract
Wound management is a notable healthcare and financial burden, accounting for >$10 billion in annual healthcare spending in the United States. A multidisciplinary approach involving orthopaedic and plastic surgeons, wound care nursing, and medical and support staff is often necessary to improve outcomes. Orthopaedic surgeons must be familiar with the fundamental principles and evidenced-based concepts for the management of acute and chronic wounds. Knowledge of surgical dressings, negative pressure wound therapy, tissue expanders, dermal apposition, biologics, and extracellular matrices can aide practitioners in optimizing wound care.
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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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Malone CH, McLaughlin JM, Ross LS, Phillips LG, Wagner RF. Progressive Tightening of Pulley Sutures for Primary Repair of Large Scalp Wounds. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1592. [PMID: 29632771 PMCID: PMC5889453 DOI: 10.1097/gox.0000000000001592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Scalp defects greater than 2 cm in diameter are not usually amenable to primary closure and require local tissue rearrangement, grafting, tissue expansion, or prolonged second intention healing. Scalp flap reconstruction is a significant undertaking that requires elevation of a total flap surface area that is 3–6 times the size of the defect, often involves profuse bleeding, and can be challenging to perform without conscious sedation or general anesthesia. Anticoagulated and medically complex patients pose additional challenges and limit options for treatment. The pulley suture uses the mechanical advantage of the pulley to distribute tension across a wound and is useful in areas of high tension such as scalp wounds. For scalp wounds greater than 2 cm, pulley sutures are placed along the length of the wound. An assistant exerts equal tension on the pulley sutures, and the surgeon sequentially ties the sutures. The sutures are tightened and retied weekly until complete scalp closure is achieved. The pulley sutures can be used for rapid primary closure of scalp wounds up to 2.5–3.0 cm in diameter under local anesthesia. For scalp wounds larger than 3 cm, we have also found that pulley sutures can be progressively tightened yielding additional tissue expansion every week. Scalp wounds greater than 3.0 cm can be easily closed via primary repair and weekly tightening of pulley sutures without the need for flap reconstruction, traditional tissue expander placement, or second intention healing.
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Affiliation(s)
- C Helen Malone
- Department of Dermatology, University of Texas Medical Branch, Galveston, Tex.; and Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Jillian M McLaughlin
- Department of Dermatology, University of Texas Medical Branch, Galveston, Tex.; and Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Lindy S Ross
- Department of Dermatology, University of Texas Medical Branch, Galveston, Tex.; and Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Linda G Phillips
- Department of Dermatology, University of Texas Medical Branch, Galveston, Tex.; and Department of Surgery, University of Texas Medical Branch, Galveston, Tex
| | - Richard F Wagner
- Department of Dermatology, University of Texas Medical Branch, Galveston, Tex.; and Department of Surgery, University of Texas Medical Branch, Galveston, Tex
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14
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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.
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15
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Braun TL, Hamilton KL, Monson LA, Buchanan EP, Hollier LH. Tissue Expansion in Children. Semin Plast Surg 2016; 30:155-161. [PMID: 27895537 DOI: 10.1055/s-0036-1593479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tissue expansion is a well-established surgical method that has been creatively applied to the management of many congenital and acquired pediatric conditions, including the removal of giant congenital melanocytic nevi and the separation of conjoined twins. Careful preoperative planning and patient follow-up are required to achieve the proper results and minimize complications. Special considerations for pediatric patients are present during each step of the process, from patient selection to postoperative care. The complication rate in tissue expansion remains high, though measures can be taken to reduce and effectively manage these complications.
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Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Kristy L Hamilton
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Laura A Monson
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Larry H Hollier
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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16
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Razzak MA, Hossain MS, Radzi ZB, Yahya NAB, Czernuszka J, Rahman MT. Cellular and Molecular Responses to Mechanical Expansion of Tissue. Front Physiol 2016; 7:540. [PMID: 27899897 PMCID: PMC5111402 DOI: 10.3389/fphys.2016.00540] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/27/2016] [Indexed: 01/08/2023] Open
Abstract
The increased use of tissue expander in the past decades and its potential market values in near future give enough reasons to sum up the consequences of tissue expansion. Furthermore, the patients have the right to know underlying mechanisms of adaptation of inserted biomimetic, its bioinspired materials and probable complications. The mechanical strains during tissue expansion are related to several biological phenomena. Tissue remodeling during the expansion is highly regulated and depends on the signal transduction. Any alteration may lead to tumor formation, necrosis and/or apoptosis. In this review, stretch induced cell proliferation, apoptosis, the roles of growth factors, stretch induced ion channels, and roles of second messengers are organized. It is expected that readers from any background can understand and make a decision about tissue expansion.
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Affiliation(s)
- Muhammad Abdur Razzak
- Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya Kuala Lumpur, Malaysia
| | - Md Sanower Hossain
- Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya Kuala Lumpur, Malaysia
| | - Zamri Bin Radzi
- Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya Kuala Lumpur, Malaysia
| | - Noor Azlin B Yahya
- Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya Kuala Lumpur, Malaysia
| | - Jan Czernuszka
- Department of Materials, University of Oxford Oxford, UK
| | - Mohammad T Rahman
- Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya Kuala Lumpur, Malaysia
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Clevenger TN, Luna G, Boctor D, Fisher SK, Clegg DO. Cell-mediated remodeling of biomimetic encapsulating hydrogels triggered by adipogenic differentiation of adipose stem cells. J Tissue Eng 2016; 7:2041731416670482. [PMID: 27733898 PMCID: PMC5040235 DOI: 10.1177/2041731416670482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 01/18/2023] Open
Abstract
One of the most common regenerative therapies is autologous fat grafting, which frequently suffers from unexpected volume loss. One approach is to deliver adipose stem cells encapsulated in the engineered hydrogels supportive of cell survival, differentiation, and integration after transplant. We describe an encapsulating, biomimetic poly(ethylene)-glycol hydrogel, with embedded peptides for attachment and biodegradation. Poly(ethylene)-glycol hydrogels containing an Arg–Gly–Asp attachment sequence and a matrix metalloprotease 3/10 cleavage site supported adipose stem cell survival and showed remodeling initiated by adipogenic differentiation. Arg–Gly–Asp–matrix metalloprotease 3/10 cleavage site hydrogels showed an increased number and area of lacunae or holes after adipose stem cell differentiation. Image analysis of adipose stem cells in Arg–Gly–Asp–matrix metalloprotease 3/10 cleavage site hydrogels showed larger Voronoi domains, while cell density remained unchanged. The differentiated adipocytes residing within these newly remodeled spaces express proteins and messenger RNAs indicative of adipocytic differentiation. These engineered scaffolds may provide niches for stem cell differentiation and could prove useful in soft tissue regeneration.
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Affiliation(s)
- Tracy N Clevenger
- Center for Stem Cell Biology and Engineering, University of California, Santa Barbara, CA, USA; Neuroscience Research Institute, University of California, Santa Barbara, CA, USA; Department of Molecular, Cellular, and Developmental Biology, University of California, Santa Barbara, CA, USA
| | - Gabriel Luna
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA; Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Daniel Boctor
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA
| | - Steven K Fisher
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA; Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Dennis O Clegg
- Center for Stem Cell Biology and Engineering, University of California, Santa Barbara, CA, USA; Neuroscience Research Institute, University of California, Santa Barbara, CA, USA; Department of Molecular, Cellular, and Developmental Biology, University of California, Santa Barbara, CA, USA
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18
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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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Huh J, Parekh SG. Use of a Continuous External Tissue Expander in Total Ankle Arthroplasty: A Novel Augment to Wound Closure. Foot Ankle Spec 2016; 9:43-7. [PMID: 26245331 DOI: 10.1177/1938640015598839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Despite major improvements in surgical technique and implant designs in total ankle arthroplasty (TAA), wound healing complications are still commonly encountered. Not only do these problems delay postoperative recovery and threaten functional outcomes, they also carry an increased risk of progression to deep wound infection, which can jeopardize ultimate retention of the implant. In an effort to reduce the high frequency of wound-related complications after TAA, we have incorporated the use of continuous external tissue expansion (CETE) to augment our closures of the anterior ankle incision. CETE is an innovative technique that is currently being used to aid in the rapid closure of acute and chronic full thickness soft tissue defects, including fasciotomy wounds, high grade open fractures, and chronic foot ulcers. By exploiting the viscoelastic properties of the skin, this technique not only facilitates wound edge approximation of full thickness defects, it also helps take tension off tenuous incisions, thus allowing them to heal and reducing the chance for wound dehiscence. This is the first description of the use of an external tissue expander for the prevention of wound healing complications in the setting of TAA. Since introducing CETE to the closure of our TAA incisions, we have seen a decrease in the number of postoperative wound complications and time to wound healing. Based on our experience, we believe that the use of CETE for the prophylactic management of tenuous surgical incisions, specifically those used in the anterior approach to the ankle during TAA, is both safe and efficacious. LEVELS OF EVIDENCE Level V: Technique tip.
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Affiliation(s)
- Jeannie Huh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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20
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Reinard KA, Zakaria HM, Qatanani A, Lee IY, Rock JP, Houin HP. Preoperative external tissue expansion for complex cranial reconstructions. J Neurosurg 2016; 125:861-868. [PMID: 26722853 DOI: 10.3171/2015.7.jns15132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reconstruction of large solitary cranial defects after multiple craniotomies is challenging because scalp contraction generally requires more than simple subcutaneous undermining to ensure effective and cosmetically appealing closure. In plastic and reconstructive surgery, soft tissue expansion is considered the gold standard for reconstructing scalp defects; however, these techniques are not well known nor are they routinely practiced among neurosurgeons. The authors here describe a simple external tissue expansion technique that is associated with low morbidity and results in high cosmetic satisfaction among patients. METHODS The authors reviewed the medical records of patients with large cranial defects (> 5 cm) following multiple complicated craniotomies who had undergone reconstructive cranioplasty with preoperative tissue expansion using the DermaClose RC device. In addition to gathering data on patient age, sex, primary pathology, number of craniotomies and/or craniectomies, history of radiation therapy, and duration of external scalp tissue expansion, the authors screened patient charts for cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess formation, dermatitis, and patient satisfaction rates. RESULTS The 6 identified patients (5 female, 1 male) had an age range from 36 to 70 years. All patients had complicating factors such as recalcitrant scalp infections after multiple craniotomies or cranial radiation, which led to secondary scalp tissue scarring and retraction. All patients were deemed to be potential candidates for rotational flaps with or without skin grafts. All patients underwent the same preoperative tissue expansion followed by standard cranial bone reconstruction. None of the patients developed CSF leak, meningitis, intracranial abscess, dermatitis, or permanent cosmetic defects. None of the patients required a reoperation. Mean follow-up was 117 days. CONCLUSIONS Preoperative scalp tissue expansion with the DermaClose RC device allows for simple and reliable completion of complicated cranial reconstruction with low morbidity rates and high cosmetic satisfaction among patients.
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Affiliation(s)
| | | | - Ahmad Qatanani
- Department of Biomedical Engineering, New Jersey Technical Institute, Newark, New Jersey
| | | | | | - Herman P Houin
- Plastic Surgery, Henry Ford Hospital, Detroit, Michigan; and
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21
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Park KU, Moquin K. Novel Use of External Tissue Expander for Management of Sternal Wound Dehiscence. Ann Thorac Surg 2015; 100:e81-3. [DOI: 10.1016/j.athoracsur.2015.06.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/08/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
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Fletcher MDA, Solomin LN. Definitive management of significant soft tissue loss associated with open diaphyseal fractures utilising circular external fixation without free tissue transfer, a comprehensive review of the literature and illustrative case. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:65-75. [PMID: 24659455 DOI: 10.1007/s00590-014-1441-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/12/2014] [Indexed: 11/24/2022]
Abstract
Accepted management of diaphyseal fractures associated with significant tissue loss is rigid intramedullary stabilisation with free or rotational musculocutaneous flap coverage. Circular external fixation is a powerful tool in the management of limb trauma and with recent advances has been developed to provide multiple techniques for which even massive tissue loss can be addressed without the need for free tissue transfer. Gradual and acute shortening, acute fracture deformation and gradual lengthening with restoration of deformity combined with distraction tissue histiogenesis can provide the surgeon with an array of options which can be precisely tailored to the particular personality of a severe open diaphyseal fracture.
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23
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Application of the orthoplastic reconstructive ladder to preserve lower extremity amputation length. Ann Plast Surg 2015; 73:183-9. [PMID: 24691339 DOI: 10.1097/sap.0b013e3182a638d8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A primary goal in traumatic lower extremity amputation management is preservation of limb length. Energy expenditure during ambulation directly correlates with residual limb length, preserved limb segments, and stable joint preservation. An additional factor affecting limb function includes achieving adequate residual limb soft tissue coverage. This report describes techniques for achieving a stable soft tissue envelope to facilitate limb length and joint preservation. METHODS A series of traumatic amputation cases with inadequate soft tissue coverage are reviewed. Concepts from the reconstructive surgery ladder were used to achieve residual limb soft tissue coverage and to preserve lower extremity amputation length. RESULTS Soft tissue coverage was accomplished through a series of methods including delayed primary closure with assistance from an external tissue expander, use of acellular dermal regenerative templates combined with split-thickness skin grafting and negative-pressure wound therapy, use of biologic scaffolds such as extracellular porcine urinary bladder matrix combined with delayed skin grafting, and local pedicle flaps or adjacent tissue rearrangements and free tissue transfers. CONCLUSIONS The preservation of residual limb length in lower extremity amputations is crucial to optimize prosthetic fitting and to obtain the maximal functional outcome. A series of cases are presented that outline soft tissue coverage options for preserving maximal residual limb length. Applying various concepts from the reconstructive ladder may allow for viable soft tissue coverage to maximize functional outcome.
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Topaz M. Invited Commentary: External tissue expansion and tension relief systems for improved utilisation of the viscoelastic properties of the skin in wound closure. Indian J Plast Surg 2015; 47:467-8. [PMID: 25593445 PMCID: PMC4292137 DOI: 10.4103/0970-0358.146682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Moris Topaz
- Department of Plastic Surgery, Hillel Yaffe Medical Centre, Hadera, Israel E-mail:
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25
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Topaz M, Carmel NN, Topaz G, Li M, Li YZ. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept: new concept for direct closure of large defects. Medicine (Baltimore) 2014; 93:e234. [PMID: 25526444 PMCID: PMC4603089 DOI: 10.1097/md.0000000000000234] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Stress-relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects. The aim of this study was to evaluate the efficiency of the TopClosure TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress-relaxation. We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress-relaxation, and following surgery as skin-secure system until complete wound closure. All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress-relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved. In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress-relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range of applications on a global scale.
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Affiliation(s)
- Moris Topaz
- From the Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel (MT); Department of Chemistry, Bar Ilan University, Ramat Gan, Israel (NNC, GT); Medical Intern, HaSharon Medical Center, Rabin Campus, Petah Tikva, Israel (NNC); Medical Intern, Wolfson Medical Center, Holon, Israel (GT); Department of Plastic Surgery, Second People's Hospital, Taiyuan, China (ML); and Department of Plastic Surgery, Deyang People's Hospital, Deyang, China (YZL)
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Senchenkov A, Agag RL, Lee J, Patel A, Valerio IL. Management of anterolateral thigh free Flap donor site defects with a continuous external tissue expander. Microsurgery 2014; 35:290-4. [DOI: 10.1002/micr.22326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/28/2014] [Accepted: 08/28/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Alex Senchenkov
- Division of Plastic Surgery; Mayo Clinic; 200 First Street SW Rochester MN
| | - Richard L. Agag
- Division of Plastic Surgery; Albany Medical College; 43 New Scotland Avenue MC 190 Albany NY
| | - Johnson Lee
- Division of Plastic Surgery; Albany Medical College; 43 New Scotland Avenue MC 190 Albany NY
| | - Ashit Patel
- Division of Plastic Surgery; Albany Medical College; 43 New Scotland Avenue MC 190 Albany NY
| | - Ian L. Valerio
- Plastic and Reconstructive Surgery Service; Walter Reed National Military Medical Center; 8901 Wisconsin Avenue Bethesda MD
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Senchenkov A. The use of continuous external tissue expander for direct closure of anterolateral thigh free flap donor sites. J Plast Reconstr Aesthet Surg 2014; 67:1766-7. [PMID: 24931773 DOI: 10.1016/j.bjps.2014.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/22/2014] [Accepted: 05/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Alex Senchenkov
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
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28
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Scientific and Clinical Abstracts From the WOCN® Society's 45th Annual Conference. J Wound Ostomy Continence Nurs 2013. [DOI: 10.1097/won.0b013e31828f9649] [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]
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