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.	胡炜, 邵银初, 李浩, 等. 不同皮肤牵张闭合器治疗皮肤软组织缺损的临床研究. 中国骨伤, 2019, 32(11): 1021-1025.
5.	韩玉卓, 陈永华, 刘冬, 等. 新型拉杆式皮肤牵张器在皮肤全层缺损创面中的应用研究. 中华创伤骨科杂志, 2021, 23(7): 627-631.
6.	苑博, 梁海东, 童致虹, 等. 可持续型皮肤牵张器在头皮及软组织缺损中的应用效果. 中华烧伤杂志, 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.
11.	贾赤宇, 周克强. 皮肤牵张器的发展及应用. 中华损伤与修复杂志 (电子版), 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.	江伟, 谌艳, 杨灵, 等. Top-closure皮肤牵张器结合伤口床准备治疗感染性皮肤软组织缺损的疗效研究. 四川医学, 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.	王刚, 李梦虎, 卜寒梅, 等. Top-Closure皮肤牵张闭合器治疗慢性不愈创面40例. 中国中西医结合外科杂志, 2018, 24(5): 631-633.
17.	陈春. 负压封闭引流技术应用于骨创伤创面软组织修复中的效果. 临床与病理杂志, 2019, 39(10): 2210-2214.
18.	张磊, 王新卫, 陈雨声, 等. 应用牵拉再生技术治疗下肢复杂软组织缺损. 中医正骨, 2021, 33(7): 53-58.
19.	孙志刚, 郭树忠, 鲁开化, 等. 皮肤伸展术在火器伤伤口闭合应用的实验研究. 中国修复重建外科杂志, 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. 皮肤伸展器的研制及临床应用. 中华整形烧伤外科杂志, 1996, 12(3): 193-195.
22.	董其强, 谷国俊, 王礼军, 等. 改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用. 中国修复重建外科杂志, 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.	吴韬光, 陈华, 聂少波, 等. 完全清醒无止血带局部麻醉技术在治疗急性跟腱断裂中的应用. 中国修复重建外科杂志, 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. 胡炜, 邵银初, 李浩, 等. 不同皮肤牵张闭合器治疗皮肤软组织缺损的临床研究. 中国骨伤, 2019, 32(11): 1021-1025.
5. 韩玉卓, 陈永华, 刘冬, 等. 新型拉杆式皮肤牵张器在皮肤全层缺损创面中的应用研究. 中华创伤骨科杂志, 2021, 23(7): 627-631.
6. 苑博, 梁海东, 童致虹, 等. 可持续型皮肤牵张器在头皮及软组织缺损中的应用效果. 中华烧伤杂志, 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.
11. 贾赤宇, 周克强. 皮肤牵张器的发展及应用. 中华损伤与修复杂志 (电子版), 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. 江伟, 谌艳, 杨灵, 等. Top-closure皮肤牵张器结合伤口床准备治疗感染性皮肤软组织缺损的疗效研究. 四川医学, 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. 王刚, 李梦虎, 卜寒梅, 等. Top-Closure皮肤牵张闭合器治疗慢性不愈创面40例. 中国中西医结合外科杂志, 2018, 24(5): 631-633.
17. 陈春. 负压封闭引流技术应用于骨创伤创面软组织修复中的效果. 临床与病理杂志, 2019, 39(10): 2210-2214.
18. 张磊, 王新卫, 陈雨声, 等. 应用牵拉再生技术治疗下肢复杂软组织缺损. 中医正骨, 2021, 33(7): 53-58.
19. 孙志刚, 郭树忠, 鲁开化, 等. 皮肤伸展术在火器伤伤口闭合应用的实验研究. 中国修复重建外科杂志, 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. 皮肤伸展器的研制及临床应用. 中华整形烧伤外科杂志, 1996, 12(3): 193-195.
22. 董其强, 谷国俊, 王礼军, 等. 改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用. 中国修复重建外科杂志, 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. 吴韬光, 陈华, 聂少波, 等. 完全清醒无止血带局部麻醉技术在治疗急性跟腱断裂中的应用. 中国修复重建外科杂志, 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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