Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Hao ^1,2 , TANG Junjun ³ , ZHANG Jun ² , BI Zheng ¹ , LI Shuangcheng ^1,3 , HU Xingxing ³ ,  CHEN Hua ³ , TANG Peifu ³

1. Graduate School of Chinese PLA General Hospital, Beijing, 100853, P. R. China;
2. The Second Surgical Department, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force, Beijing, 100027, P. R. China;
3. Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;

Corresponding?author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Disposable skin stretch closure; skin and soft tissue defect; difficult to close wounds; skin stretch

DOI：

10.7507/1002-1892.202201068

Video：

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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 cm²/day, with a mean of 3.6 cm²/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.

Citation： GUO Hao, TANG Junjun, ZHANG Jun, BI Zheng, LI Shuangcheng, HU Xingxing, CHEN Hua, TANG Peifu. Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 760-765. doi: 10.7507/1002-1892.202201068 Copy

1.	Ali M, Reda FM, Issaoui H, et al. Management of a high-energy soft tissue injury of the lower extremity using negative pressure wound therapy with instillation and dwell time and a reticulated open cell foam dressing. Wounds, 2020, 32(12): 375-377.
2.	Hu R, Ren YJ, Yan L, et al. A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children’s feet and ankles. Injury, 2015, 46(10): 2019-2023.
3.	Wang P, Cui MY, Zhao J, et al. Compound grafting of residual vascularized fibular head flap to reconstruct contralateral lateral malleolus: A case report. Medicine (Baltimore), 2017, 96(52): e9501.
4.	胡煒, 邵銀初, 李浩, 等. 不同皮膚牽張閉合器治療皮膚軟組織缺損的臨床研究. 中國骨傷, 2019, 32(11): 1021-1025.
5.	韓玉卓, 陳永華, 劉冬, 等. 新型拉桿式皮膚牽張器在皮膚全層缺損創面中的應用研究. 中華創傷骨科雜志, 2021, 23(7): 627-631.
6.	苑博, 梁海東, 童致虹, 等. 可持續型皮膚牽張器在頭皮及軟組織缺損中的應用效果. 中華燒傷雜志, 2020, 36(12): 1204-1207.
7.	Morisada MV, Tollefson TT. Commentary on “Augmented skin grafting: A new rung in the reconstructive ladder” by Landeen, et al: Less invasive options for patients with significant comorbidities. Facial Plast Surg Aesthet Med, 2022, 24(2): 130-131.
8.	Landeen KC, Davis SJ, Dedhia RD, et al. Augmented skin grafting: A new rung in the reconstructive ladder. Facial Plast Surg Aesthet Med, 2022, 24(2): 126-129.
9.	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, 2014, 47(3): 467-468.
10.	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.
11.	賈赤宇, 周克強. 皮膚牽張器的發展及應用. 中華損傷與修復雜志 (電子版), 2018, 13(6): 425-431.
12.	Topaz M, Carmel NN, Silberman A, et al. The TopClosure^? 3S System, for skin stretching and a secure wound closure. Eur J Plast Surg, 2012, 35(7): 533-543.
13.	江偉, 諶艷, 楊靈, 等. Top-closure皮膚牽張器結合傷口床準備治療感染性皮膚軟組織缺損的療效研究. 四川醫學, 2021, 42(11): 1132-1137.
14.	Durden F, Tiwari P, Kocak E. Can the DermaClose device contribute to periwound tissue ischemia and necrosis: a case presentation and discussion? Plast Surg Nurs, 2012, 32(3): 132-133.
15.	Gould L, Li WW. Defining complete wound closure: Closing the gap in clinical trials and practice. Wound Repair Regen, 2019, 27(3): 201-224.
16.	王剛, 李夢虎, 卜寒梅, 等. Top-Closure皮膚牽張閉合器治療慢性不愈創面40例. 中國中西醫結合外科雜志, 2018, 24(5): 631-633.
17.	陳春. 負壓封閉引流技術應用于骨創傷創面軟組織修復中的效果. 臨床與病理雜志, 2019, 39(10): 2210-2214.
18.	張磊, 王新衛, 陳雨聲, 等. 應用牽拉再生技術治療下肢復雜軟組織缺損. 中醫正骨, 2021, 33(7): 53-58.
19.	孫志剛, 郭樹忠, 魯開化, 等. 皮膚伸展術在火器傷傷口閉合應用的實驗研究. 中國修復重建外科雜志, 2001, 15(2): 82-85.
20.	Hirshowitz B, Kaufman T, Ullman J. Reconstruction of the tip of the nose and ala by load cycling of the nasal skin and harnessing of extra skin. Plast Reconstr Surg, 1986, 77(2): 316-321.
21.	周黎安, 桂斌, 查元坤, 等. 皮膚伸展器的研制及臨床應用. 中華整形燒傷外科雜志, 1996, 12(3): 193-195.
22.	董其強, 谷國俊, 王禮軍, 等. 改良可調式皮膚牽張閉合器在皮膚及軟組織缺損修復中的應用. 中國修復重建外科雜志, 2017, 31(12): 1481-1484.
23.	Song M, Zhang Z, Liu T, et al. EASApprox^? skin-stretching system: A secure and effective method to achieve wound closure. Exp Ther Med, 2017, 14(1): 531-538.
24.	MacKay BJ, Dardano AN, Klapper AM, et al. Multidisciplinary application of an external tissue expander device to improve patient outcomes: A critical review. Adv Wound Care (New Rochelle), 2020, 9(9): 525-538.
25.	Reinard KA, Zakaria HM, Qatanani A, et al. Preoperative external tissue expansion for complex cranial reconstructions. J Neurosurg, 2016, 125(4): 861-868.
26.	Santiago GF, Bograd B, Basile PL, et al. Soft tissue injury management with a continuous external tissue expander. Ann Plast Surg, 2012, 69(4): 418-421.
27.	Manista GC, Dennis A, Kaminsky M. Surgical management of compartment syndrome and the gradual closure of a fasciotomy wound using a DermaClose device. Trauma Case Rep, 2018, 14: 1-4.
28.	Arain AR, Cole K, Sullivan C, et al. Tissue expanders with a focus on extremity reconstruction. Expert Rev Med Devices, 2018, 15(2): 145-155.
29.	de Boccard O, Müller C, Christen T. Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room’s throughput. J Plast Reconstr Aesthet Surg, 2021, 74(9): 2149-2155.
30.	Tahir M, Chaudhry EA, Zaffar Z, et al. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure. Bone Joint Res, 2020, 9(7): 429-439.
31.	吳韜光, 陳華, 聶少波, 等. 完全清醒無止血帶局部麻醉技術在治療急性跟腱斷裂中的應用. 中國修復重建外科雜志, 2022, 36(3): 279-283.

1. Ali M, Reda FM, Issaoui H, et al. Management of a high-energy soft tissue injury of the lower extremity using negative pressure wound therapy with instillation and dwell time and a reticulated open cell foam dressing. Wounds, 2020, 32(12): 375-377.
2. Hu R, Ren YJ, Yan L, et al. A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children’s feet and ankles. Injury, 2015, 46(10): 2019-2023.
3. Wang P, Cui MY, Zhao J, et al. Compound grafting of residual vascularized fibular head flap to reconstruct contralateral lateral malleolus: A case report. Medicine (Baltimore), 2017, 96(52): e9501.
4. 胡煒, 邵銀初, 李浩, 等. 不同皮膚牽張閉合器治療皮膚軟組織缺損的臨床研究. 中國骨傷, 2019, 32(11): 1021-1025.
5. 韓玉卓, 陳永華, 劉冬, 等. 新型拉桿式皮膚牽張器在皮膚全層缺損創面中的應用研究. 中華創傷骨科雜志, 2021, 23(7): 627-631.
6. 苑博, 梁海東, 童致虹, 等. 可持續型皮膚牽張器在頭皮及軟組織缺損中的應用效果. 中華燒傷雜志, 2020, 36(12): 1204-1207.
7. Morisada MV, Tollefson TT. Commentary on “Augmented skin grafting: A new rung in the reconstructive ladder” by Landeen, et al: Less invasive options for patients with significant comorbidities. Facial Plast Surg Aesthet Med, 2022, 24(2): 130-131.
8. Landeen KC, Davis SJ, Dedhia RD, et al. Augmented skin grafting: A new rung in the reconstructive ladder. Facial Plast Surg Aesthet Med, 2022, 24(2): 126-129.
9. 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, 2014, 47(3): 467-468.
10. 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.
11. 賈赤宇, 周克強. 皮膚牽張器的發展及應用. 中華損傷與修復雜志 (電子版), 2018, 13(6): 425-431.
12. Topaz M, Carmel NN, Silberman A, et al. The TopClosure^? 3S System, for skin stretching and a secure wound closure. Eur J Plast Surg, 2012, 35(7): 533-543.
13. 江偉, 諶艷, 楊靈, 等. Top-closure皮膚牽張器結合傷口床準備治療感染性皮膚軟組織缺損的療效研究. 四川醫學, 2021, 42(11): 1132-1137.
14. Durden F, Tiwari P, Kocak E. Can the DermaClose device contribute to periwound tissue ischemia and necrosis: a case presentation and discussion? Plast Surg Nurs, 2012, 32(3): 132-133.
15. Gould L, Li WW. Defining complete wound closure: Closing the gap in clinical trials and practice. Wound Repair Regen, 2019, 27(3): 201-224.
16. 王剛, 李夢虎, 卜寒梅, 等. Top-Closure皮膚牽張閉合器治療慢性不愈創面40例. 中國中西醫結合外科雜志, 2018, 24(5): 631-633.
17. 陳春. 負壓封閉引流技術應用于骨創傷創面軟組織修復中的效果. 臨床與病理雜志, 2019, 39(10): 2210-2214.
18. 張磊, 王新衛, 陳雨聲, 等. 應用牽拉再生技術治療下肢復雜軟組織缺損. 中醫正骨, 2021, 33(7): 53-58.
19. 孫志剛, 郭樹忠, 魯開化, 等. 皮膚伸展術在火器傷傷口閉合應用的實驗研究. 中國修復重建外科雜志, 2001, 15(2): 82-85.
20. Hirshowitz B, Kaufman T, Ullman J. Reconstruction of the tip of the nose and ala by load cycling of the nasal skin and harnessing of extra skin. Plast Reconstr Surg, 1986, 77(2): 316-321.
21. 周黎安, 桂斌, 查元坤, 等. 皮膚伸展器的研制及臨床應用. 中華整形燒傷外科雜志, 1996, 12(3): 193-195.
22. 董其強, 谷國俊, 王禮軍, 等. 改良可調式皮膚牽張閉合器在皮膚及軟組織缺損修復中的應用. 中國修復重建外科雜志, 2017, 31(12): 1481-1484.
23. Song M, Zhang Z, Liu T, et al. EASApprox^? skin-stretching system: A secure and effective method to achieve wound closure. Exp Ther Med, 2017, 14(1): 531-538.
24. MacKay BJ, Dardano AN, Klapper AM, et al. Multidisciplinary application of an external tissue expander device to improve patient outcomes: A critical review. Adv Wound Care (New Rochelle), 2020, 9(9): 525-538.
25. Reinard KA, Zakaria HM, Qatanani A, et al. Preoperative external tissue expansion for complex cranial reconstructions. J Neurosurg, 2016, 125(4): 861-868.
26. Santiago GF, Bograd B, Basile PL, et al. Soft tissue injury management with a continuous external tissue expander. Ann Plast Surg, 2012, 69(4): 418-421.
27. Manista GC, Dennis A, Kaminsky M. Surgical management of compartment syndrome and the gradual closure of a fasciotomy wound using a DermaClose device. Trauma Case Rep, 2018, 14: 1-4.
28. Arain AR, Cole K, Sullivan C, et al. Tissue expanders with a focus on extremity reconstruction. Expert Rev Med Devices, 2018, 15(2): 145-155.
29. de Boccard O, Müller C, Christen T. Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room’s throughput. J Plast Reconstr Aesthet Surg, 2021, 74(9): 2149-2155.
30. Tahir M, Chaudhry EA, Zaffar Z, et al. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure. Bone Joint Res, 2020, 9(7): 429-439.
31. 吳韜光, 陳華, 聶少波, 等. 完全清醒無止血帶局部麻醉技術在治療急性跟腱斷裂中的應用. 中國修復重建外科雜志, 2022, 36(3): 279-283.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of disposable skin stretch closure in treatment of difficult to close skin and soft tissue defects

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