A novel skin-stretching device for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the efficacy of a novel self-designed skin-stretching device for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture.Methods:From July 2018 to January 2021, 9 patients were treated at Orthopedic Hospital, Southeast Hospital Affiliated to Xiamen University for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture. They were 6 males and 3 females, aged from 19 to 61 years (mean, 42.6 years). The interval between their initial internal fixation and the present operation ranged from 14 to 75 days (average, 47.3 days). Of them, one developed wound dehiscence due to fat liquefaction, 2 necrosis of skin and soft tissue along the wound edges, and 6 incision infection. Their fusiform skin and soft tissue defects had formed after routine expansion of the wound, with an area of 5.0 cm×2.0 cm to 7.0 cm×3.5 cm, and all their wounds were positive by Pinch test. After a Kirschner wire with a diameter of 2.0 was placed on both sides of the wound, our novel self-designed skin-stretching device was installed. Intraoperatively, depending on the soft tissue conditions on both sides, the wound was closed acutely by about 5 mm in width. The threaded rod of the skin-stretching device was adjusted every day after operation to gradually reduce the wound surface until the wound edge was closed and sutured without tension. During wound stretch, the visual analogue scale (VAS), wound approaching time, stretch speed, wound healing time, complications and the Vancouver Scar Scale (VSS) for the wound scar at the last follow-up were recorded.Results:All the 9 patients were followed up for 8 to 18 months (average, 12.5 months). The wounds were successfully closed in all the patients. The time for wound closure (till the suture) ranged from 8 to 15 d, averaging 12.1 d; the stretch rate from 1 to 3 mm/d, averaging 2 mm/d; the time for complete wound healing (to the suture removal) from 22 to 30 d, averaging 26.8 d; the VAS score during the stretch from 3 to 7 points, averaging 4.9 points; the VSS score from 2 to 7 points, averaging 4.1 points. There was no recurrence of surgical site infection, skin re-necrosis or reoperation in the patients.Conclusions:In the treatment of skin-soft tissue defects and bone exposure caused by various reasons after internal fixation of calcaneal fracture, our novel self-designed skin-stretching device is an effective in situ wound repair instrument, showing advantages of simple operation, less trauma and high safety. It is suggested that the stretch speed should average 2 mm/d, which is well tolerated by patients.