Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage—Clinical Outcome of 34 Patients

Abstract

Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length ( W/ L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables ( P < .05 Kruskal–Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A ( W/ L ＞ 0.5) were more difficult to close than in group B ( W/ L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.

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

“…The combination of rubber bands and skin staples could also be used as a SSD [ 38 , 47 ]. The elastic bands from #7 surgical gloves may also be good choices [ 48 ]. Chen and Su reported a combination of a transfuser and nylon ligatures with a similar composition to ETEs [ 39 ].…”

“…Among all the studies included, 20 reported using the external tissue expansion technique in 209 patients undergoing fasciotomies. The application devices included a vessel loop [ 50–53 ], SureClosure® [ 54 ], Ty-raps [ 27 ], SBWCD [ 28 ], ETEs [ 29 , 55 ], Wisebands® [ 56 ], DermaClose® [ 57 ], TopClosure® [ 33 , 58 ], ABRA® [ 34 , 59 ], EASApprox® [ 60 ] and homemade devices [ 40 , 41 , 47 , 48 ].…”

“…The wounds were mainly located in the extremities and trunks. The devices used for reconstruction of the posttraumatic defects included the vessel loop [ 25 ], SureClosure® [ 26 , 54 ], ETEs [ 55 ], Proxiderm® [ 30 , 69 ], Wisebands® [ 31 ], DermaClose® [ 57 , 77 ], TopClosure® [ 33 , 58 , 76 ], EASApprox® [ 60 ], KeKe® [ 43 , 75 ] and some homemade devices, such as nice knots [ 2 ], rubber bands [ 48 ] and KWs [[ 41 , 46 ],[ 72–74 ]].…”

“…Twenty studies with 325 patients with chronic ulcers were enrolled in the final analysis. The application devices included SureClosure® [ 26 , 78 ], Proxiderm® [ 30 , 69 , 79 ], Wisebands® [ 31 ], DermaClose® [ 57 ], TopClosure® [ 33 , 58 ], ABRA® [ 80 ], EASApprox® [ 35 ], NSSDs [ 37 , 81 ], loop suture [ 40 ] and homemade devices [ 38 , 39 , 47 , 48 , 72 ].…”

“…Fourteen studies met the inclusion criteria for the meta-analysis of the successful wound closure rate [ 26 , 30 , 33 , 35 , 38–40 , 47 , 48 , 57 , 58 , 72 , 79 , 80 ]. The pooled successful wound closure rate was 99.5% (95% CI = 97.6–100%, I 2 = 11%, p = 0.34) ( Figure 6b ).…”