ABSTRACT
BACKGROUND: Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE: To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS: From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS: Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION: There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS: The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.
HISTORIQUE: Les plaies fermées sous tension excessive et les anomalies cutanées qui ne peuvent pas être fermées par une intervention primaire représentent un problème quotidien pour le plasticien. OBJECTIF: Évaluer un nouveau système de soulagement des tensions (SST) pour étirer la peau et assurer la fermeture des plaies. MÉTHODOLOGIE: De septembre 2013 à mars 2014, une série consécutive de 41 patients chinois présentant 43 plaies ont été inscrits pour recevoir 50 cycles de traitement par SST. Le SST était utilisé pour deux principales applications cliniques : fermer diverses plaies chirurgicales ou traumatiques et assurer la fermeture des plaies après une suture à haute tension. Les chercheurs ont colligé l'information générale et détaillée au sujet de ce traitement et de ses complications. Les rendez-vous de suivi ont eu lieu de trois à six mois après la fermeture des plaies. RÉSULTATS: La largeur des plaies résiduelles moyennes diminuait d'environ 20 % tous les deux jours pendant les cycles de traitement par SST. L'infection était la complication la plus courante (cinq cas). Les autres complications étaient la déhiscence (deux cas) et l'ulcère de pression (un cas). Au rendez-vous de suivi six mois plus tard (21 plaies chez 20 patients), tant le processus de cicatrisation que la cicatrice étaient acceptables. EXPOSÉ: Il n'y a pas de contre-indications absolues au traitement par SST. Les auteurs ont formulé des directives pour prévenir et traiter les complications les plus courantes. CONCLUSIONS: Les résultats démontrent que le traitement par SST est une méthode simple et efficace pour assurer la fermeture primaire de plaies complexes et d'importantes anomalies de la peau et des tissus mous. Des études aléatoires plus vastes s'imposent pour approfondir l'évaluation de l'efficacité, des indications, des complications et du rapport coût-efficacité de ce traitement novateur par SST.
ABSTRACT
Objective To investigate the performance of surgical management in facial skin malignancies.Methods From January 2000 to December 2006,65 patients with facial skin malignancies,including47 cases of basal cell carcinoma.10 cases of squamous cell carcinoma,3 cases of dermatofibrosarocoma protuberans,2 cases of malignant melanomas,and one case of malignant acanthoma,hemangioendotheliosar-coma and sebaceous carcinoma,respectively,were collected and managed with wide resection followed by reconstruction.In order to achieve a thorough resection,frozen sections were prepared and subjected to pathological examination during the operation process to ensure the margins of resection were free of malignancy.Reconstruction was carried out by direct closure,or with local random flaps,extended flaps,free skin grafts.Resuits All defects were managed by one-stage reconstruction.The survival rate of skin flaps/grafts was 100%,and a satisfactory appearance and function was achieved.During the follow-up from 6 months to 5 years,local relapse was observed in one patient with basal cell carcinoma and one with squamous eell carcinoma,lymphatic metastasis in one with squamous cell carcinoma.Distant metastasis occurred in a patient with malignant melanoma.who died consequently.Conclusions Thorough resection is the key to prevent relapse of facial skin malignancies after surgery.Appropriate reconstruction may favor the restoration of facial appearance,and local random flaps appear to be the best reconstruction strategy.
