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External Constant Tension Expansion of Soft Tissue for the Treatment of
Ulceration of the Foot and Ankle A clinical series of the management of 74 lesions in the foot and ankle region in 67patients using a constant tension-approximating device is presented. The technical aspects of this methodology are detailed as they have been developed over the past 4 years. The indications, contraindications, and the requirements to obtain a successful result are discussed. The differences, as well as the possible advantages over other mechanical devices used in wound management, are discussed. The incidence and degree of complications are considered to be minimal when compared to both flap procedures and internal expansion technologies.. The Journal of Foot & Ankle Surgery 39(5):321-328, 2000 In the fourth century Hippocrates stated: "Healing is a matter of time, but it is sometimes also a matter of opportunity." Since ancient times, physicians have pursued methods to accelerate the rate of healing by local applications. At the present time, two such modalities for treatment exist: those that medically expedite epithelialization of the wound and those that employ surgical interventions such as skin grafts, internal tissue expansion devices, or myocutaneous flap procedures. Methods that encourage epithelialization require a significant time period for epithelial coverage of the wound and result in thin, fragile scar tissue that is prone to breakdown. This has led surgeons in this century to develop procedures and devices that cover the wound rapidly with skin that can withstand the rigors of everyday life. In 1957, Neuman (1) created additional tissue by inserting a balloon under the scalp in the management of ear defects. Radovan (2) expanded on Newman's development by using modern technology. In the 1960s, Ger introduced the technique of closing wounds by muscle (3) and myocutaneous flaps (4). Military surgeons have, for years, used simple devices for the intermittent tightening of heavy sutures to slowly close contaminated wounds. Excalera (5) described progressive wound closure with constant static tension traction and Hirschowitz (6) developed a skin-stretching device that applied a high degree of traction as a single procedure in the closure of open wounds. In 1994, Ger (7) described the use of an external tension device in the management of wounds and ulcers in a small number of lesions of the foot and ankle. This report describes the use of the devices in a large series of 74 lesions in 67 patients and includes refinements in technique and consideration of the advantages and contraindications based on the larger experience and longer follow-up. Wounds of the lower extremity are generally the most difficult to close, particularly those of the foot and ankle, where the deleterious effects of neuropathy, vascular disorders, and diabetes find their greatest expression. |
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