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.	宋树坤, 高树林, 王宪清. 多个筋膜皮下瓣组合修复小腿大面积皮肤缺损. 中国修复重建外科杂志, 2008, 22(10): 1278-1280.
4.	肖容. 不同筋膜皮瓣在胫骨骨折伴软组织缺损修复中的应用. 医学临床研究, 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.	王叶武, 金玉梅, 张勇, 等. 自制硅胶线皮肤牵张技术在皮肤软组织缺损中的临床效果. 实用骨科杂志, 2016, 22(11): 1048-1050.
7.	倪国骅, 吴学建, 张德洪, 等. 皮肤弹性牵张法闭合小腿骨筋膜室高压减张切口. 中国矫形外科杂志, 2016, 24(4): 382-384.
8.	张金明, 陈小萱, 崔永言, 等. 应用皮肤牵张带治疗足踝部皮肤软组织缺损. 中华骨科杂志, 2004, 24(1): 29-31.
9.	桂万里, 杨娥, 张恒术. 皮肤牵张器在瘢痕治疗中的临床应用效果观察. 中华烧伤杂志, 2017, 33(3): 139-144.
10.	苑博, 王寿宇, 梁海东, 等. 新型拉杆式皮肤牵张器在修复 26 例患者四肢皮肤软组织缺损中的应用. 中华烧伤杂志, 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.	马翔宇, 王东. 开放性骨折修复: 创面感染、植入物选择及预后评价. 中国组织工程研究, 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.	Zöllner 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.	鲁开化, 艾玉峰, 郭树忠, 等. 新编皮肤软组织扩张术. 上海: 第二军医大学出版社, 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. 开放性骨折治疗进展. 国际骨科学杂志, 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. 宋树坤, 高树林, 王宪清. 多个筋膜皮下瓣组合修复小腿大面积皮肤缺损. 中国修复重建外科杂志, 2008, 22(10): 1278-1280.
4. 肖容. 不同筋膜皮瓣在胫骨骨折伴软组织缺损修复中的应用. 医学临床研究, 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. 王叶武, 金玉梅, 张勇, 等. 自制硅胶线皮肤牵张技术在皮肤软组织缺损中的临床效果. 实用骨科杂志, 2016, 22(11): 1048-1050.
7. 倪国骅, 吴学建, 张德洪, 等. 皮肤弹性牵张法闭合小腿骨筋膜室高压减张切口. 中国矫形外科杂志, 2016, 24(4): 382-384.
8. 张金明, 陈小萱, 崔永言, 等. 应用皮肤牵张带治疗足踝部皮肤软组织缺损. 中华骨科杂志, 2004, 24(1): 29-31.
9. 桂万里, 杨娥, 张恒术. 皮肤牵张器在瘢痕治疗中的临床应用效果观察. 中华烧伤杂志, 2017, 33(3): 139-144.
10. 苑博, 王寿宇, 梁海东, 等. 新型拉杆式皮肤牵张器在修复 26 例患者四肢皮肤软组织缺损中的应用. 中华烧伤杂志, 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. 马翔宇, 王东. 开放性骨折修复: 创面感染、植入物选择及预后评价. 中国组织工程研究, 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. Zöllner 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. 鲁开化, 艾玉峰, 郭树忠, 等. 新编皮肤软组织扩张术. 上海: 第二军医大学出版社, 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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