Clinic Research Of New Tension Relief System For Treatment Of Skin And Soft Tissue Defects

Objective:With the process of social modernization and development of transportation industry,the incidence of trauma is increasing dramatically,skin and soft tissue defects are more commonly seen.How to efficiently cover the skin and soft tissue defects,especially large areas,is a challenge for Orthopaedic surgery.The application of dermatotraction for primary skin closure do solve some of the problems of skin and soft tissue defects.Whereas,skin stretching devices are made by different producer,each have their own characteristics.In this study,we observed the clinical use of Top Closure?3S System(TRS)and homemade skin stretching device in skin and soft tissue defects caused by trauma,and the advantages and disadvantages of the two groups were analyzed.Comparing the ads and pros,we tried to provide theoretical basis for appropriate clinical choice in the use of skin stretching technology.Methods: Forty-one patients treated with dermatotraction for trauma induced skin and soft tissue defect were included(mean age 43.2,between 28 to 64 years,female n=13 male n=28),from June 2015 to October 2016,in the department of orthopedics of our hospital.TRS group n=18,homemade skin stretch group n=23.Position of trauma(upper limbs n=11,lower limbs n=24,backside n=6).In Top Closure?3S System group,after a complete debridement,a pair of paste plate 2cm from the edge of the margin firmly fixed,fix the skin to appropriate tension,for the wound with higher tension treated with stitch and leather nails one-time closure.In homemade skin stretch group,after debridement thoroughly,fixed with silicone,rubber band material through the wound on both sides of the skin 2cm from the edge of the margin,intermittent suture may actually close the wound,for those wounds couldn’t be one-time closure,appropriate traction of the edge daily,until the edge of the skin can be directly suture.All cases were followed up,from 3 to 12 months,an average of 6.2 months.Comparing the mean rate of primary closure,time ofoperation,time of wound healing,the complication of operation,and Visual analogue scale(VAS)were analyzed to assessed the pain,Vancouver scar scale(VSS)to assess postoperative scars.Data collected were analyzed by the corresponding statistical method.Results:Forty-one patients healed,after treatment with a Top Closure?3S System or homemade skin stretch.Direct closure rate 88.9%(16/18)in TRS group,52.2%(12/23)in self-made skin stretch group,the difference was statistically significant(p<0.05).There was no significant difference between the two groups on intraoperative blood loss and operation time(p> 0.05).Wound healing time between the two groups is of significance(p<0.05).Operative complications were statistically significant between the two groups(p <0.05),TRS group 5.6%(1/18)and self-made skin stretch group 39.1%(9/23).The differences in VSS scores and VAS scores were significant between two groups(p<0.05).Conclusion: Firstly,Top Closure?3S System or self-made skin stretching device treatment for large areas of skin and soft tissue defects can achieve a better effect,and reduce or avoid the skin graft or flap surgery.Secondly,in comparison of two kinds of treatment,TRS skin stretching closure is more minimal invasive,short healing period,less complications,wound healing well and good outlook,etc.