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Wound management by constant tension approximation
A new technique for smooth wound closure that encourages angiogenesis and epithelial proliferation.
Ralph Ger, MD, FRCS
Abstract
An ideal result in wound healing is expedited closure with full-thickness skin, as opposed to thin, fragile epithelium prone
to future breakdown. To help achieve accelerated healing by full thickness skin, a device has been designed that applies constant tension traction to the wound margins. The device acts by both approximating the
wound and by encouraging tissue and skin generation through stimulating angiogenesis and epithelial proliferation.
This study includes 31 patients with 36 wounds of varying etiologies treated over 28 days. The wounds were inspected every 3 to 5 days at which time the dressings were changed and new devices applied, as needed. All but five of the wounds healed completely with full thickness skin within the study period (average: 15 days; range: 7 - 28 days). The longest healing times occurred in the patients with pressure ulcers. Using a formula for determining healing time based on excisional wound dimension, the expected healing time of a 3cm wide foot ulcer with uninterrupted progress is 41 days. The time for such a wound to heal in this study was 21 days. The approximating device accelerated wound healing by full thickness skin for the wounds included in this study. Other considerations when using this method include cost, patient compliance and indications/contraindications. Ostomy/Wound Management Vol 42, No. 9 October 1996
Introduction
There are a variety of ways to speed or encourage the natural healing of a wound. For example, there is evidence to
suggest that non-thermal pulsed high frequency electromagnetic energy applied to cells accelerates healing.
Most methods to accelerate healing consist of topical applications which are said to provide a beneficial local milieu. Yet it is doubtful if topical methods can further hasten the healing of a wound where the repair is already proceeding in a normal manner.
A disadvantage of allowing natural healing is that the final result is a wound covered with thin, fragile epithelium. This healed wound may
be prone to breakdown, expecially in areas subjected to stress and/or pressure, such as weight-bearing areas.
The achievement of full thickness coverage usually necessitates an operative procedure of some magnitude, such as skin expansion techniques and various forms of skin flaps with or without incorporated muscle.
Recently a simple method has been introduced which helps accelerate healing and achieves full thickness coverage. This method uses the
principle of applying constant tension traction to the wound margins with one or more specially designed devices.
The application of constant tension acts by both approximating the wound and stimulating tissue and skin generation, the latter by stimulating angiogenesis and increasing the mitotic activity of the epithelial cells. The placement of the approximating devices may involve some surgical dissection (see materials and methods) which should be performed by residents, medical or osteopathic physicians, or podiatrists. However, a nurse may be able to place the device under the supervision of a physician depending on the regulations and/or institutions. The technical aspects, clinical results, indications and contraindications associated with the use of this device are presented.
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