Closure Of Large Wounds Research Articles

Automatic wound closure system: closure of large wounds by stretching the skin around the wound.

Large-wound treatment often requires autologous skin grafting or skin flap transfer, causing iatrogenic secondary injuries. Thus, we have developed an automatic wound closure system that consists of a stretch module, microcontroller, and touch screen. Full-thickness wounds (8 × 14cm) on Bama miniature pigs were manually closed by direct suture in control animals and with three different tension levels performed by the automatic device in the experimental animals. Wound-closure conditions, post-closure healing, and scars were evaluated. Post-operative microscopic changes in collagen fibers, local cell apoptosis, and changes in vascular density were compared between the two wound-closure techniques. In the control group and the first experimental group, which used a traction force of 15 N, primary wound closure could not be achieved. The other two experimental groups used a traction force of 30 N and 60 N and all wounds achieved primary closure. Collagen-fiber stretching was observed histologically in all groups and collagen-fiber breakdown occurred in some wounds when the traction force was 60 N. Scar hyperplasia was significantly reduced in the automatic wound closure system groups. The collagen content decreased, cell apoptosis increased, and vascular density decreased in local tissues in the early post-closure stage, but eventually recovered to normal-skin levels. In summary, we developed an automatic wound closure system that effectively and safely stretches dermal-collagen fibers under an appropriate traction force (30 N) and stretch wound-peripheral skin to cover the wound, achieve primary closure, and reduce scar hyperplasia.

The Effect of Strain Rate on the Stress Relaxation of the Pig Dermis: A Hyper-Viscoelastic Approach.

The understanding of strain rate-dependent mechanical properties of the skin is important for accurate prediction of its biomechanics under different loading conditions. This study investigated the effect of strain rate, i.e., 0.025/s (low), 0.5/s (medium), and 1.25/s (high), ranging in the physiological loading rate of connective tissue, on the stress-relaxation response of the porcine dermis. Results show that in the initial phase of the relaxation, the value of stress relaxation (extent of relaxation) was found higher for high strain rate. However, the equilibrium stress was found strain rate independent. A Mooney-Rivlin-based five-term quasi-linear viscoelastic (QLV) model was proposed to determine the effect of strain rate on the stress-relaxation behavior of the porcine dermis. The value of relaxation modulus G1 and G2 were found higher for the high strain rate, whereas the reverse trend was observed for G3, G4, and G5. Moreover, the value of time constants τ1,τ2,τ3τ4, and τ5 were found higher for low strain rate. Statistical analysis shows no significant difference in the values of G5, τ4, and τ5 among the three strain rates. The proposed model was found capable to fit the stress-relaxation response of skin with great accuracy, e.g., root-mean-squared-error (RMSE) value equal to 0.015 ± 0.00012 MPa. Moreover, this hyper-viscoelastic model can be utilized: to quantify the effects of age and diseases on the skin; to simulate the stresses on sutures during large wound closure and impact loading.

New application of purse string suture in skin cancer surgery.

Closure of large wounds may require full-thickness skin grafts, but their use is burdened by donor tissue availability and morbidity; the use of the purse string technique is an elegant way to overcome this problem. The study highlights the gain in terms of graft donor site morbidity and oncological radicality. The study included a group of 47 patients who underwent surgical excision for skin cancer and whose wounds were covered using a purse string suture and a skin graft. Radius of the defect left was measured after the lesion's excision and after the purse string suture. Thereafter, the difference between the initial defect area and the area after purse string suture was calculated. Initial defects ranged from 3.85 to 61.5 cm2 . After skin graft, the purse string suture ranged between 2.2 and 40 cm2 (mean area = 14 cm2 ). Gained area before the graft measured from 1.3 to 21.5 cm2 (mean gained area = 7.1 cm2 ). Average reduction was 33%. The technique allows a reduction of the size of the area to be grafted and the skin graft donor area, thus increasing the possibility of the feasibility of full-thickness grafts. In addition, it allows an optimal observation both of the area of tumour excision and margins during follow-up controls.

Closure of large wounds using rubber bands in rabbits.

to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8 cm long by 12 cm wide. All animals were observed for 21 days. two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

The dermatotraction technique for closure of fasciotomy wound

Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible. This communication describes a technique that uses 1-0 prolene suture material, skin stapler and the natural stretching ability of the skin to enable primary closure of wounds. The technique described uses dermatotraction to stretch the skin, is a cost-effective way to achieve primary closure of large wounds with supplies that are readily available in every operating room.

Closure of large wound with rubber elastic circular strips - case report

added in the application of subcutaneous and superficial fascia, in order to avoid additional suffering the edge of the skin, which could worsen the condition of the wound to this technique. This modification improved the aesthetic appearance and location prevented the formation of the lateral wound scars. The objective of this report is to present a new technique for closure of extensive surgical wounds through elastic suture, using circular elastic rubber bands.

Elastic Rubber Strips to Heal Large Wounds of the Body Wall

Closure of large wounds is a difficult surgical challenge. This article reports on the effective closure of large surgical wounds using elastic rubber strips. One to 3 circular elastic rubber strips were sutured by applying moderate tension to the opposite edges of 30 large wounds in 28 patients. The strips were sutured in a successive "X" fashion by crossing one over the other. These rubber strips were replaced when they ruptured or after their tension had reduced because of the closure of the wounds. Complete closure of the wounds was achieved with no further need for any surgical procedure or device. One patient with laparostomy and colostomy presented with difficulty on adapting the colostomic bag, and the rubber strips were removed. The rubber strip had little effect on a large wound of the skull. In the late postoperative follow-up, 3 of the 15 closed laparostomies developed incisional hernias, and all these patients were subjected to hernioplasties with good results. The use of circular elastic rubber strips maintained at moderate tension is a simple, effective, and inexpensive surgical option for healing large wounds. It is readily available at any hospital and requires no extensive surgical experience.

Closure of Large Wounds of the Body Wall with Elastic Rubber Strip

Closure of Large Wounds of the Body Wall with Elastic Rubber Strip

Delayed Primary Closure of Diabetic Foot Wounds using the DermaClose™ RC Tissue Expander

Closure of large wounds has been a challenge in podiatric surgery, especially after large defects created by ulcer debridement, metatarsal resection and amputation. The DermaCloseTM RC tissue expander allows for closure of large defects without the need for traditional complex skin closure, tissue grafting or creation of skin and tissue flaps. Skin anchors made of surgical steel clips are used with a tension controller to allow for gentle skin stretching on the subcutaneous planes of the wound or defect. It also has special application in the closure of chronic wounds. Two case reports are presented to describe this technique.

Neutrophil migration across model intestinal epithelia: Monolayer disruption and subsequent events in epithelial repair

BACKGROUND & AIMS: Acute inflammation of the intestine is associated with transepithelial migration of polymorphonuclear leukocytes (PMNs) and epithelial wounds that rapidly reseal. The aim of this study was to determine mechanisms by which such PMN-induced epithelial wounds reseal.METHODS: Epithelial wound closure was modeled in vitro using T84 intestinal epithelial cells and PMNs. Wound closure was analyzed by confocal microscopy and by determination of barrier function. Wounds were highlighted by apical labeling with antibody to a basolaterally restricted ligand, beta1-integrin.RESULTS: High-density PMN transepithelial migration for 70-110 minutes produced multifocal epithelial wounds that were 1-120 microm in diameter and markedly diminished epithelial barrier function that returned to baseline within 12-20 hours. Large wound closure was initiated by cell flattening and extension of F-actin/vinculin/paxillin-enriched lamellipodia at the leading edge. As wounds became small (approximately <30 microm), epithelial cells at the wound edges assumed columnar phenotype with poorly formed or absent lamellipodia. Apical localized circumferential, dense F-actin/myosin II rings were found to encircle such wounds, suggesting final closure by a sphincter-like contraction.CONCLUSIONS: These data model mucosal repair in acute inflammatory conditions and, for the first time, show sequential early and late mechanisms by which epithelial discontinuities repair.(Gastroenterology 1997 Nov;113(5):1489-500)

The Use of Fascial Plication to Facilitate Wound Closure Following Microscopically Controlled Surgery

The closure of large wounds created by the Mohs method of skin cancer removal may often be facilitated by the plication of the underlying fascia. Fascial plication causes the movement of tissue without direct tension and vascular compromise on involved skin. This may be referred to as tissue drag. The tissue, once dragged toward the closure point by fascial movement, may often be stretched a further distance. Only the tension caused by stretching affects the vascular viability of the skin. This tension-alleviating maneuver may permit closure of wounds that might otherwise be subject to ischemic complications if only standard cutaneous and subcutaneous closures are employed.

Sustained-Grip, Pressure-Release Tissue Forceps

To the Editor.— The sustained pinch necessary to hold pickup forceps during plastic closure of large wounds may cause fatigue of the thenar musculature. This can be avoided by using a large bulldog vascular clamp, modified to act as skin forceps by adding a 7.5-cm knurled handle (Figure). After grasping the skin edge, tension between the operator's thumb and index finger is relaxed and the instrument is lightly balanced in the hand. Spring tension in the bulldog clamp assures its hold on the tissue. Pinch is released by light pressure at the finger grips. This action is opposite to that of conventional forceps. Therefore, thenar tension need not be maintained to assure skin purchase. The instrument's jaws are serrated for nonslip retention of vessels, so it cannot damage tissue while holding firm. The forceps are easily fabricated from readily available components, simple to handle, and prevent the discomfort often occurring