Comparison of Wound Healing Between Conventional Tie-over Dressing and Silicone Sheeting after Skin Grafting

PURPOSE: We compared wound healing between the conventional tie-over dressing and silicone sheeting after skin grafting in patients with skin defects. MATERIALS AND METHODS: Of a total of 30 cases of skin defects, 15 underwent conventional tie-over dressing and the remaining 15 underwent silicone sheeting skin grafting, we compared hematoma formation and infection status between the 2 techniques 1 and 2 weeks after operation. RESULTS: Hematoma was not observed in all cases. The wound infection rate decreased in silicone group. CONCLUSIONS: Silicone sheeting skin graft may be helpful in reducing wound infection.

New Tie-over Dressing Method Using Hooks and Rubber Bands

PURPOSE: Though its general usage, traditional tie-over dressing using suture has a few drawbacks such as difficulty in re-fixation after its opening especially when hematoma or seroma has occurred. It is rather difficult to maintain a stable dressing on curvy parts of body like flank, buttocks and that leads to unsatisfactory results of the surgery. Authors recommend a quick and repeatedly doable method, tie-over dressing that incorporates the usage of hooks and rubber bands. METHODS: Debridement was done at a recipient site to be able to do skin graft. A right size of skin graft was prepared and placed upon the defect site with suture. Enough number of hooks were attached using Blue nylon at the normal skin of the edge of grafted area. We Applied dressing with ointment and fluffy gauze then fixed the dressing by attaching a rubber band at the hook to give a certain amount of tension. One or two days after the surgery, we opened the tie-over dressing and repeated the tie-over dressing by reusing the hooks and rubber band. RESULTS: The skin grafts were all successfully taken and by repeating tie-over dressing using hooks and rubber, we could take the advantage of shortened the dressing time and eliminate the inconvenience of the patient and the surgeon by using bandages and fixing tapes. CONCLUSION: The advantage of tie over dressing using hooks and rubber bsnds are its easy re-doability early detection of probable complications, preventability of reoccurence of hematoma and seroma. Therefore, authors report this as considering the tie-over dressing using hooks and rubber bands is recommendable.

Efficacy of Tie-over Dressing Using Silicone Gel Sheet in Skin Graft on Flat Surface

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications. Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.

A Simple and Rapid Tie-Over Dressing with Skin Stapler and Round Rubber Band

The tie-over dressing is a time consuming work because the long silk sutures get tangled and one must spend time on securing the ends. However it is a necessary procedure for a better take of the skin graft. The skin graft was prepared as a split-thickness graft with or without meshing. After hemostasis of the recipient defect, the prepared skin was placed and tailored for the defect. The skin stapler hold the skin margin, split-thickness graft and a round rubber band in one stitch. And the mesh gauze with ointment was applied over the grafted skin and the bulky moist dressing was applied with fluffy gauze and cotton. Over the bulky dressing the rubber bands crossed over and fixed on the other side of the surrounding edge on the normal skin area by the skin stapler. In case of need, splint and compressive dressing with elastic bandage was applied. From January, 2002 to September, 2002, in 15 patients, this method has been used and proven satisfactory. Skin graft was well taken and the time for tie-over dressing can be reduced markedly. We can ensure the adherence of a skin graft to the bed of the wound by continuous pressure dressing. This technique is simple, fast, and no needs of any special device or dressing materials.

Clinical Cases of Composite Graft for Reconstruction of Fingertip Amputations using Combination Procedure of Tie-over Dressing and Drain

The treatment of fingertip amputation is difficult and controversial. Although the microsurgery has been accepted as a procedure of choice, in distal location, however, both reattachment of amputated portion as a composite graft and microvascular anastomosis are prone to failure. The fact that microscopic reconstruction of vessels is safer means of replacing amputated digits, makes considerably smaller the need to use the technique of composite graft nowadays. Nevertheless, there still remains a group of distal digital amputations which cannot be replaced by microsurgical procedure and the composite grafting is the only way of achieving a full length digit with a normal nail complex. Nowadays, it is generally accepted that replacement should be made as early as possible for the prevention of bacterial and proteolytic activity. However, if the replacement is made so quickly that bleeding doesn't stop, there is a layer of clot blocking adhesion between the two surfaces, and the union will not be achieved. We report a new strategy: the tie-over dressing ensures not only fixation, but also hemostasis, and the drainage application is used to drain retained blood, so composite graft doesn't need to be delayed until the bleeding stops. We achieved good results by using this new technique.

Usefulness of Nasal Splints (Aquaplast(R)) for Securing Full Thickness Skin Graft (FTSG) / 대한피부과학회지

BACKGROUND: For securing FTSG, bolus tie-over dressing is a universally accepted method, but it has some definite disadvantages. For example, bulky dressing inhibits the drainage from graft bed and can lead to maceration by occlusion. Time and effort is necessary to secure dressing and the help of an assistant is also mandatory to tie the suture much easier. OBJECTIVES: In an attempt to find a better dressing material, we evaluated the usefulness of thermoplastic nasal splints (Aquaplast(R)) for securing graft in FTSG reconstruction. METHODS: Thirteen patients with surgical defects following tumor excision from the nose(9 patients), forehead(1), lip(1), hand(1), shin(1) ranging from 12mm to 40mm in the largest diameter were reconstructed with a FTSG. For securing FTSG, a heat-moldable nasal splint was heated, contoured in place over sutured graft on recipient area with/without suture of the splint with skin. RESULTS: All of the 13 FTSG secured with nasal splints showed a good take with a satisfactory cosmetic results. Except hypertrophic scars in 4 patients, which were not significant and improved with several times intralesional injection of triamcinolone, there were no other complications. CONCLUSION: We have found a heat-moldable nasal splint to be useful material to secure FTSG, especially for the complex contoured area such as nose or ear. This technique saves time and effort and there is no need of an assistant.

Simple method of tie-over dressing

Tie-over dressing is commonly used in order to immobilize the skin graft. The classic method takes too much time and effort, and various apparatuses of the other modifications are somewhat large and bulky, especially in the surgery for hands, therefore, we have developed a simplified method for tie-over dressing. We placed several key stitches with absorbable suture material, and passed silk sutures from one margin of the graft to the opposite without tying. Then after putting saline-soaked cotton balls below and above the silk sutures, we tied the silk suture together applying appropriate pressure. This method has the following advantages: 1. speed of application 2. double compression 3. easy to remove