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The Use of External Tissue Expansion in the Management of Wounds and
Ulcers A series of 43 wounds and ulcers in 37 patients were treated with the use of constant-tension approximation devices for periods ranging from 7 to 28 days. The etiologies of the lesions were diabetes; posttraumatic, including iatrogenic causes; neuropathic; pressure sores; and collagen disease. The approximation device is described and the technique of applying the device is detailed. The results are presented in tabulated form. The contraindications to the use of this methodology are discussed and the importance of patient selectivity is stressed. Evidence is presented to indicate that constant-tension approximation increases the healing rate as well as provides partial or complete full-thickness coverage, depending on the size of the wound. Such coverage reduces the recurrence rate and is usually only achieved by an operative approach, which is thus avoided. The socioeconomic advantages of this approach are mentioned. Ann Plast Surg 1997;38:352-357 The healing of wounds continues to test the minds of those working in this interesting field. Methods of accelerating the rate of healing and/or the healing of slow- or nonhealing wounds are constantly being sought. The biological approaches that use factors that are involved in the healing process have been mostly disappointing. In the recent past mechanical methods of closing wounds have been introduced that rely on the intermittent application of an approximating force of known or unknown strength [1-3]. Most recently a method has been introduced that applies a constant-tension force, which allows chronic stretching of the skin. This method resembles the stretching that occurs by the subcutaneous implantation of a balloon [4], but it is carried out externally. This presentation is an account of the clinical experience acquired following the use of this external skin expansion technique. |
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