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

Abstract

A device that can both achieve and maintain wound closure by serial tightening of a loop suture was developed. The device consists of 3 components: a hollow plastic cylinder with a 1-way locking mechanism, a flat plastic strip passing though the cylinder, and a plastic cushion between the cylinder and the skin. The body of the device is composed of a soft cylinder and a hard strip. This difference in flexibility enables the device to absorb impacts of positional changes and daily activities, while the device preserves tension of loop suture and wound closure ().(Figure is included in full-text article.)After debridement or excision of a lesion, the passage of 0-1 nylon suture is designed. The nylon suture is threaded through the deep dermis across the wound. Both ends of the suture are then tied to make a loop, which is secured to 2 holes at one end of a plastic strip. The plastic strip, which holds the loop suture, is pulled away from the skin gradually through a hollow plastic cylinder to approximate wound margins ().(Figure is included in full-text article.)From January 2003 to August 2003, the device was applied 21 times in 15 consecutive patients. A mean stretching of 42.0 mm was performed for defects with a mean shortest dimension of 24.5 mm (from 2 mm to 60 mm). All 21 wounds were closed primarily (21/21 = 100%), and the closure was maintained successfully for 18 wounds (18/21 = 85.7%) in 13 patients (13/15 = 86.7%). The device was left in situ for as long as 102 days (average application time of 34.5 days). Three wound dehiscences (3/21 = 14.3%) occurred in 2 diabetic foot patients, which were cured by skin grafting. In 2 sacral pressure ulcer patients, minimal skin lacerations were caused by the loop sutures at the skin entrance site but without true wound dehiscence. These lacerations healed with minimal debridement and routine wound dressing within 2 weeks. This instrument was devised to overcome the limitations of previous skin stretching methods. It has wider indications and shows better compliances. In particular, because of its longer period of application, the device does not only stretch the skin to achieve wound closure, but also helps maintain it during wound healing.