|
A Clinical Trial of Wound Closure by Constant Tension Approximation
Ralph Ger, MD, James T. Evans, East Meadow, New York, Robert Oddsen, ME
BACKGROUND
Wound that heal slowly may pass through a subacute phase and proceed to reach a chronic situation. The latter may heal
slowly, if at all. These wounds often heal by secondary intention with a single layer of epithelium that has a tendency to break down. Methods that expedite healing by full-thickness skin usually involve operative
procedures. A non operative method of achieving coverage of tardy wounds with full thickness skin, partial or complete depending on the wound, would be valuable.
PATIENTS AND METHODS
A device has been designed that approximates the wound margins by applying constant low-grade tension over a period
of days or weeks. One or more devices have been applied to the wounds of 25 patients to date.
RESULTS
Healing has been obtained in those patients (20) where the devices were used optimally. In 5 patients, optimal use was not
possible, mostly for socioeconomic reasons; the latter included noncompliance, insurance problems, economic difficulties, and personal considerations.
In these 5 cases, healing was obtained in the 3 that were available for follow-up, full-thickness skin coverage being estimated by grid photography to be in the 80% to 90% range. One patient was lost to follow-up after the wound was 95% covered by full-thickness skin. One patient whose wound reduces in size declined further treatment after 12 days of treatment.
CONCLUSIONS
It appears that when constant-tension, low-grade force is applied to subacute and chronic wounds, healing is accelerated
and, depending on the wound, a considerable number of ulcers can be closed by full-thickness skin.
Am J Surg. 1996;171:331-334.
Ulcerative lesions that heal with difficulty, or fail to heal, predominantly affect the lower extremities, particularly the foot, and lead to
extensive morbidity and substantial mortality. The leading underlying etiologies include the diabetic state, posttraumatic lesions, and pressure ulcers.
Currently, healing depends on medical and surgical measures, the latter being difficult and at times dangerous. Failure is not uncommon, and a major amputation may be the final result; for example, 5 of 6 amputations involve diabetic patients. Presently, healing, especially if attained by non operative means, results in a scarred area covered by the thin epithelium that accompanies healing by secondary intention, a situation associated with a substantial recurrence rate. The breakdown rate could be reduced if the healed wound could be covered by full-thickness skin that is able to withstand the pressures of daily living. As ulcers are the major cause of amputations, methods that heal an ulcer and prevent recurrence deserve consideration. This communication concerns the preliminary results achieved with the use of a method of wound closure by constant tension wound approximation.
Return To Top
|
