Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Closure techniques for challenging wounds under tension: A case series     (1452)

Jake Hindmarch 1 , Phaethon Karagiannis 1 , Hardeep Jhattu 1 , Isobel Yeap 1 , Alexander Phoon 1
  1. Plastic Surgery, Royal Prince Alfred Hospital , Sydney, NSW, Australia


Large wounds under tension are difficult to close and may require local flaps or skin grafts. Fasciotomy wounds are often treated with skin grafts, which may be aesthetically displeasing, and leave areas of insensate tissue. Craniotomy wounds can be difficult to manage due to the bone flaps and vessel grafts that may lay beneath skin. We present the following cases to highlight the advantages of using delayed primary closure with an external tissue expansion device such as Dermaclose®.



A continuous external tissue expansion system, DermaClose®, was used to close large fasciotomy wounds and a craniotomy wound. The devices were left in situ for a period of one to two weeks and then removed.



Within one week, a craniotomy wound was able to be closed primarily. Within two weeks, three large fasciotomy wounds were closed primarily. Both cases were originally planned for either large skin grafts or complex local flaps. Both patients were left with minimal scaring and were pleased with the cosmesis.  



To our knowledge, this is the first use of DermaClose® reported in Australia. We present these cases to highlight the benefits of delayed primary closure of wounds under tension. The benefits of using a device like this include a straight scar, avoiding aesthetically displeasing skin grafts, and avoiding painful skin graft donor site wounds. Subsequent revision of split skin grafts with serial excision can be performed to achieve a similar end result but would require additional general anaesthetics and post-operative recovery.



These cases were presented to highlight an alternative to skin grafting and local skin flaps. External tissue expansion systems should be considered for fasciotomy wounds and craniotomy wounds. Larger studies are needed to evaluate the cost-effectiveness of the device and long-term sequelae such as quality of scarring and patient satisfaction.