Application of skin stretcher for repair of postoperative skin and soft tissue defects in tibial fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Jialei , YAN Zhaokui , ZHONG Gang ,  FANG Yue

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

FANG Yue, Email: fangyue1968@163.com

Keywords：

Tibial fracture; skin defect; skin stretching

DOI：

10.7507/1002-1892.201708072

Video：

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ObjectiveTo discuss the efficacy of skin stretcher applied for repair of postoperative skin and soft tissue defects in tibial fractures.MethodsBetween April 2016 and March 2017, 15 cases with skin and soft tissue defects after tibial fractures fixation were treated with the skin stretcher. There were 11 males and 4 females with an age of 24-59 years (mean, 37.5 years). The causes of injury included traffic accident in 7 cases, bruise in 3 cases, falling from height in 3 cases, and falling in 2 cases; without nerve and vascular injury in all patients. These cases were followed up 1-3 months after their first surgery, consisting of 3 closed fractures treated with open reduction and plate and screw fixation, 12 open fractures treated with external fixation after debridement. The area of skin defects ranged from 14 cm×5 cm to 20 cm×7 cm, all of which were stripped or spindle shaped skin defects. First, the skin was penetrated by two Kirschner wires which were locked by skin stretchers on both sides of the skin defect longitudinally. Then, the tension of skin stretchers was timely adjusted according to the skin flap blood supply and muscle compression. Finally, Kirschner wires and skin stretchers were removed when the edge of skin contacted and been sutured.ResultsAll skin and soft tissue defects were covered after stretching for 6-13 days. The interrupted sutured wounds healed at 12 days. Clinical scores of wound healing decreased from 3.40±0.51 at immediate postoperatively to 1.27±0.46 at 12 days postoperatively, showing significant difference (t=12.911, P=0.000). All the patients were followed up 4-12 months (mean, 6.5 months). After stretching, the skin color, elasticity, and pain and touch feeling were similar with the normal skin, and the hair growth was normal. After operation, 1 case of nail tract infection and 2 cases of calf discomfort occurred, and all were relieved after treatment.ConclusionIt is an effective method for repairing postoperative skin and soft tissue defects in tibial fractures with the application of skin stretchers.

Citation： CHEN Jialei, YAN Zhaokui, ZHONG Gang, FANG Yue. Application of skin stretcher for repair of postoperative skin and soft tissue defects in tibial fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 596-600. doi: 10.7507/1002-1892.201708072 Copy

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2.	Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
3.	宋樹坤, 高樹林, 王憲清. 多個筋膜皮下瓣組合修復小腿大面積皮膚缺損. 中國修復重建外科雜志, 2008, 22(10): 1278-1280.
4.	肖容. 不同筋膜皮瓣在脛骨骨折伴軟組織缺損修復中的應用. 醫學臨床研究, 2016, 33(1): 54-56.
5.	Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and plastic treatment of severe open fracture of tibia. J Bone Joint Surg (Br), 2000, 82(7): 959-966.
6.	王葉武, 金玉梅, 張勇, 等. 自制硅膠線皮膚牽張技術在皮膚軟組織缺損中的臨床效果. 實用骨科雜志, 2016, 22(11): 1048-1050.
7.	倪國驊, 吳學建, 張德洪, 等. 皮膚彈性牽張法閉合小腿骨筋膜室高壓減張切口. 中國矯形外科雜志, 2016, 24(4): 382-384.
8.	張金明, 陳小萱, 崔永言, 等. 應用皮膚牽張帶治療足踝部皮膚軟組織缺損. 中華骨科雜志, 2004, 24(1): 29-31.
9.	桂萬里, 楊娥, 張恒術. 皮膚牽張器在瘢痕治療中的臨床應用效果觀察. 中華燒傷雜志, 2017, 33(3): 139-144.
10.	苑博, 王壽宇, 梁海東, 等. 新型拉桿式皮膚牽張器在修復 26 例患者四肢皮膚軟組織缺損中的應用. 中華燒傷雜志, 2016, 32(12): 732-734.
11.	Freeman LJ, Pettit GD, Robinette JD, et al. Tissue reaction to suture material in the feline linea alba. A retrospective, prospective, and histologic study. Vet Surg, 1987, 16(6): 440-445.
12.	Wagner M, Frigg R. AO manual of fracture management internal fixators, concepts and cases using LCP and LISS. Stuttgart: Ieme, 2006: 135-154.
13.	馬翔宇, 王東. 開放性骨折修復: 創面感染、植入物選擇及預后評價. 中國組織工程研究, 2015, 19(26): 4258-4264.
14.	Zollner AM, Buganza Tepole A, Gosain AK, et al. Growing skin-tissue expansion in pediatric forehead reconstruction. Biomech Model Mechanobiol, 2012, 11(6): 855-867.
15.	Baker SR. Fundamentals of expanded tissue. Head Neck, 1991, 13(4): 327-333.
16.	Takei T, Mills I, Arai K, et al. Molecualr basis for tissue expansion:clinical implications for the surgeon. Plast Reconstr Surg, 1998, 102(1): 247-258.
17.	Pietramaggiori G, Liu P, Scherer SS, et al. Tensile forces stimulate vascular remodeling and epidermal cell proliferation in living skin. Ann Surg, 2007, 246(5): 896-902.
18.	Gurtner GC, Werner S, Barrandon Y, et al. Wound repair and regeneration. Nature, 2008, 453(7193): 314-321.
19.	Wong VW, Akaishi S, Longaker MT, et al. Pushing back:wound mechanotransduction in repair and regeneration. J invest Dermatol, 2011, 131(11): 2186-2196.
20.	Z?llner AM, Holland MA, Honda KS, et al. Growth on demand: Reviewing the mechanobiology of stretched skin. J Mech Behav Biomed Mater, 2013, 28: 495-509.
21.	Huahui Z, Dan X, Hongfei J, et al. Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study. Plast Surg (Oakv), 2016, 24(3): 177-182.
22.	魯開化, 艾玉峰, 郭樹忠, 等. 新編皮膚軟組織擴張術. 上海: 第二軍醫大學出版社, 2007: 55.
23.	Hirshowitz B, Lindenbaum E, Har-Shai Y. A skin-stretching device for the harnessing of the viscoelastic properties of skin. Plast Reconstr Surg, 1993, 92(2): 260-270.
24.	Wilhelmi BJ, Blackwell SJ, Mancoll JS, et al. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg, 1998, 41(2): 215-219.

1. 余斌. 開放性骨折治療進展. 國際骨科學雜志, 2013, 34(1): 6-10.
2. Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
3. 宋樹坤, 高樹林, 王憲清. 多個筋膜皮下瓣組合修復小腿大面積皮膚缺損. 中國修復重建外科雜志, 2008, 22(10): 1278-1280.
4. 肖容. 不同筋膜皮瓣在脛骨骨折伴軟組織缺損修復中的應用. 醫學臨床研究, 2016, 33(1): 54-56.
5. Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and plastic treatment of severe open fracture of tibia. J Bone Joint Surg (Br), 2000, 82(7): 959-966.
6. 王葉武, 金玉梅, 張勇, 等. 自制硅膠線皮膚牽張技術在皮膚軟組織缺損中的臨床效果. 實用骨科雜志, 2016, 22(11): 1048-1050.
7. 倪國驊, 吳學建, 張德洪, 等. 皮膚彈性牽張法閉合小腿骨筋膜室高壓減張切口. 中國矯形外科雜志, 2016, 24(4): 382-384.
8. 張金明, 陳小萱, 崔永言, 等. 應用皮膚牽張帶治療足踝部皮膚軟組織缺損. 中華骨科雜志, 2004, 24(1): 29-31.
9. 桂萬里, 楊娥, 張恒術. 皮膚牽張器在瘢痕治療中的臨床應用效果觀察. 中華燒傷雜志, 2017, 33(3): 139-144.
10. 苑博, 王壽宇, 梁海東, 等. 新型拉桿式皮膚牽張器在修復 26 例患者四肢皮膚軟組織缺損中的應用. 中華燒傷雜志, 2016, 32(12): 732-734.
11. Freeman LJ, Pettit GD, Robinette JD, et al. Tissue reaction to suture material in the feline linea alba. A retrospective, prospective, and histologic study. Vet Surg, 1987, 16(6): 440-445.
12. Wagner M, Frigg R. AO manual of fracture management internal fixators, concepts and cases using LCP and LISS. Stuttgart: Ieme, 2006: 135-154.
13. 馬翔宇, 王東. 開放性骨折修復: 創面感染、植入物選擇及預后評價. 中國組織工程研究, 2015, 19(26): 4258-4264.
14. Zollner AM, Buganza Tepole A, Gosain AK, et al. Growing skin-tissue expansion in pediatric forehead reconstruction. Biomech Model Mechanobiol, 2012, 11(6): 855-867.
15. Baker SR. Fundamentals of expanded tissue. Head Neck, 1991, 13(4): 327-333.
16. Takei T, Mills I, Arai K, et al. Molecualr basis for tissue expansion:clinical implications for the surgeon. Plast Reconstr Surg, 1998, 102(1): 247-258.
17. Pietramaggiori G, Liu P, Scherer SS, et al. Tensile forces stimulate vascular remodeling and epidermal cell proliferation in living skin. Ann Surg, 2007, 246(5): 896-902.
18. Gurtner GC, Werner S, Barrandon Y, et al. Wound repair and regeneration. Nature, 2008, 453(7193): 314-321.
19. Wong VW, Akaishi S, Longaker MT, et al. Pushing back:wound mechanotransduction in repair and regeneration. J invest Dermatol, 2011, 131(11): 2186-2196.
20. Z?llner AM, Holland MA, Honda KS, et al. Growth on demand: Reviewing the mechanobiology of stretched skin. J Mech Behav Biomed Mater, 2013, 28: 495-509.
21. Huahui Z, Dan X, Hongfei J, et al. Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study. Plast Surg (Oakv), 2016, 24(3): 177-182.
22. 魯開化, 艾玉峰, 郭樹忠, 等. 新編皮膚軟組織擴張術. 上海: 第二軍醫大學出版社, 2007: 55.
23. Hirshowitz B, Lindenbaum E, Har-Shai Y. A skin-stretching device for the harnessing of the viscoelastic properties of skin. Plast Reconstr Surg, 1993, 92(2): 260-270.
24. Wilhelmi BJ, Blackwell SJ, Mancoll JS, et al. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg, 1998, 41(2): 215-219.

Chinese Journal of Reparative and Reconstructive Surgery

Application of skin stretcher for repair of postoperative skin and soft tissue defects in tibial fractures

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