Subscribe to RSS
Role of Preoperative Skin Stretching in Single-Stage Wound Closure
Background Mechanical skin stretching (SS) is now becoming one of the commonly sought after procedures for wound healing. This study was aimed to assess the efficacy of preoperative SS for the closure of large wounds and to evaluate various postoperative outcome parameters.
Methodology An observational study was conducted from December 2017 to May 2019 where a sample size of 30 patients was included with inclusion criteria being wounds of ≥5 cm width that require surgical management, presence of sufficient healthy skin edge of the wound/scar (at least one) for the stretching procedure, and age between 18 and 70 years. SS devices used were the top closure tension relief system. Postoperatively, various parameters were recorded to evaluate outcomes and complications.
Results Majority of wounds that is 16 (53.3%) were <50 cm2, 9 (30%) were between 50 and 75 cm2, and 5 (16.7%) were >75 cm2. The mean duration of stretch was 2.3 ± 0.82 weeks. For 30 wounds treated with staged cycles of wound closure, there was a significant difference between every two visit points, i.e., 10%. The mean patient-reported patient and observer scar assessment scale score was 3.5 ± 0.93. Twenty-five cases (83.3%) had uneventful postoperative recovery. Twenty-seven patients (90%) reported an improved aesthetic outcome. Fourteen patients (46.7%) reported some improvement in function.
Conclusion The study concluded that the SS devices are the simple and effective method for the primary closure of large and challenging wounds and skin defects.
The study is in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000.
Ethics Approval and Consent to Participate
Duly informed consent was obtained in all the cases.
Article published online:
31 October 2022
© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Fang L, Zhou C, Yang M. ‘Expansion in-situ’ concept as a new technique for expanding skin and soft tissue. Exp Ther Med 2013; 6 (05) 1295-1299
- 2 Patel PA, Elhadi HM, Kitzmiller WJ, Billmire DA, Yakuboff KP. Tissue expander complications in the pediatric burn patient: a 10-year follow-up. Ann Plast Surg 2014; 72 (02) 150-154
- 3 Topaz M, Carmel N-N, Silberman A, Li MS, Li YZ. The TopClosure® 3S System, for skin stretching and a secure wound closure. Eur J Plast Surg 2012; 35 (07) 533-543
- 4 Liang MD, Briggs P, Heckler FR, Futrell JW. Presuturing—a new technique for closing large skin defects: clinical and experimental studies. Plast Reconstr Surg 1988; 81 (05) 694-702
- 5 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 (03) 177-182
- 6 Draaijers LJ, Tempelman FR, Botman YA. et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 2004; 113 (07) 1960-1965 , discussion 1966–1967
- 7 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 (02) 260-270
- 8 Armstrong DG, Sorensen JC, Bushman TR. Exploiting the viscoelastic properties of pedal skin with the sure closure skin stretching device. J Foot Ankle Surg 1995; 34 (03) 247-253
- 9 Narayanan K, Futrell JW, Bentz M, Hurwitz D. Comparative clinical study of the sure-closure device with conventional wound closure techniques. Ann Plast Surg 1995; 35 (05) 485-491
- 10 Wiger P, Blomqvist G, Styf J. Wound closure by dermatotraction after fasciotomy for acute compartment syndrome. Scand J Plast Reconstr Surg Hand Surg 2000; 34 (04) 315-320
- 11 Turgut G, Ozcan A, Sümer O, Yeşiloğlu N, Baş L. Reconstruction of complicated scalp defect via skin traction. J Craniofac Surg 2009; 20 (01) 263-264
- 12 Ismavel R, Samuel S, Boopalan PR, Chittaranjan SB. A simple solution for wound coverage by skin stretching. J Orthop Trauma 2011; 25 (03) 127-132
- 13 Escalera GA, Swan KG. Progressive wound closure with constant tension traction: combat theater application. Mil Med 1993; 158 (01) 60-63
- 14 Bashir AH. Wound closure by skin traction: an application of tissue expansion. Br J Plast Surg 1987; 40 (06) 582-587
- 15 Lee ET. A new wound closure achieving and maintaining device using serial tightening of loop suture and its clinical applications in 15 consecutive patients for up to 102 days. Ann Plast Surg 2004; 53 (05) 436-441
- 16 Marek DJ, Copeland GE, Zlowodzki M, Cole PA. The application of dermatotraction for primary skin closure. Am J Surg 2005; 190 (01) 123-126
- 17 Imran A, Brajesh P, Sarfraz AS, Rajesh M. Wound closure by using Ty-Raps: an innovative top-closure. Int J Sci Res 2018; 7 (05) 26-29
- 18 Cheng LF, Lee JT, Hsu H, Wu MS. Simple skin-stretching device in assisted tension-free wound closure. Ann Plast Surg 2017; 78 (3, Suppl 2): S52-S57
- 19 Kalra A, Lowe A, Jumaily AAI. An overview of factors affecting the skin's Young's modulus. J Aging Sci 2016; 4: 1-5
- 20 Firooz A, Rajabi-Estarabadi A, Zartab H, Pazhohi N, Fanian F, Janani L. The influence of gender and age on the thickness and echo-density of skin. Skin Res Technol 2017; 23 (01) 13-20
- 21 Verhaegen PD, van der Wal MB, Bloemen MC. et al. Sustainable effect of skin stretching for burn scar excision: long-term results of a multicenter randomized controlled trial. Burns 2011; 37 (07) 1222-1228