Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study.

OBJECTIVE: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. METHOD: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. RESULTS: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. CONCLUSION: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. DECLARATION OF INTEREST: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds: A Systematic Review.

A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported success in the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.

Multilayer Mattress Stitches for Complicated Wounds in Spine Surgery.

INTRODUCTION: Local infection and prolonged fluid discharge account for most complications in lumbar spine surgery. This report is a brief description of a useful technique for revision of complicated, draining wounds with surprisingly positive results that otherwise frequently require multiple surgical interventions. TECHNICAL NOTE: We describe the postoperative course of three patients, with prolonged and continuous serosanguineous discharge from the skin incision, who underwent wound revision with multilayered mattress stitches after open decompressive or instrumented spinal surgery. For this purpose, a thick monofilament suture is passed through the skin, subcutaneous fatty tissue, and paravertebral muscle in the fashion of a vertical mattress stitch while the loop above the skin level is augmented using a soft silicone capillary drainage to distribute tension along the wound margin. CONCLUSIONS: None of the patients treated with the multilayered mattress stitches required further surgical intervention. In this small case series, the multilayered mattress stitches augmented with soft silicone tubing were a useful technique for treating complicated lumbar surgical wounds with prolonged serosanguineous discharge.

Multimodal Conservative Treatment of Complicated Open Wound After Total Knee Replacement Arthroplasty in Patients With Comorbidities.

Total knee replacement arthroplasty is a common procedure and postoperative wound complications are sometimes inevitable. Although invasive reconstructive surgery may be an option for nonhealed wounds, such procedures can limit early rehabilitation, adversely affecting the range of joint motion. Patients can achieve a wider range of motion if they undergo early rehabilitation with a conservative approach. From 2015 to 2017, 5 patients with comorbidities who underwent total knee replacement arthroplasty were referred to the reconstructive surgery department for nonhealed open wounds. Depending on their comorbidities and conditions, the patients underwent negative-pressure wound therapy based on multimodal conservative treatment. During the treatment, the patients continued rehabilitation. In the 5 patients, the mean duration of complete wound healing was 65.2 days (range = 57-81), during which all open wounds were well healed. For final wound closure, the patients underwent skin grafting, dermatotraction, or collagen dressing. Four patients achieved ranges of joint motion over 100 degrees after treatment. We believe that early coverage is important for open wounds. For complicated open wounds after total knee replacement arthroplasty in patients with comorbidities, less invasive multimodal treatment along with early rehabilitation may be more effective to achieve adequate final range of joint motion.

Negative pressure wound therapy-assisted dermatotraction for the closure of large open wounds in a patient with non-clostridial gas gangrene.

Case: A 53-year-old woman developed septic shock associated with non-clostridial gas gangrene. She presented to the emergency department with two large open wounds on both thighs and in her sacral region. Non-enhanced computed tomography showed air density in contact with the right iliopsoas, which extended to the posterior compartment of the thigh. We made repeated efforts at surgical debridement of the wound with resection of necrotic tissues. Outcome: Using negative pressure wound therapy-assisted dermatotraction, the pus pockets and the wound dehiscence decreased in size. Using this method we were successful in achieving delayed closure without skin grafts. Conclusion: Negative pressure wound therapy can be an effective treatment for large and infected open contoured wounds. Negative pressure wound therapy-assisted dermatotraction might be beneficial for poorly healing, large, open wounds in patients in poor condition and with insufficient reserve to tolerate reconstructive surgery.

How to Close a Limb Fasciotomy Wound: An Overview of Current Techniques.

Early fasciotomy is the gold standard of prevention and treatment of compartment syndrome; however, the resulting wounds may significantly increase morbidity. To address the challenge of timely and safe closure of fasciotomy wounds, numerous methods have been described. A thorough search of medical databases PubMed/MEDLINE, ScienceDirect, SCOPUS, EMBASE, and Google Scholar was conducted for articles published between 1976 and 2013 using the search terms "limb fasciotomy wound closure," "open wound management," "skin stretching," and "fasciotomy complications." A total of 49 articles on technique descriptions, case reports of 2 or more patients, and of complications and comparative studies regarding limb fasciotomy wound closure were included. Details of the duration of treatment, advantages and disadvantages, direct cost, and complications were data extracted for each technique from the 49 studies included in this overview. Thorough knowledge of available techniques and their comparative advantages is essential for their clinical implementation, careful selection of patients, management of possible complications, decreased morbidity, and hospital recovery time and is also crucial for optimization of functional and aesthetic outcomes.

Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients.

BACKGROUND: Necrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction. METHODS: A retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. Next, the extended NPWT was applied over the wound. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure. RESULTS: After the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm(2) to 29.37 cm(2); p = 0.002), as five out of eight patients achieved direct wound closure. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. Two Fournier's gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence. CONCLUSIONS: Extended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery.