Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review

Abstract

Significance: Continuous external tissue expansion (CETE) is a versatile tool in soft tissue injury management, and could be an addition to the traditional reconstructive ladder. Recent Advances: This critical review discusses the principles and application of CETE, covering a company-sponsored consensus meeting on this emerging technology and highlighting the DermaClose Ò (Synovis Micro Companies Alliance, Inc., Birmingham, AL) device's unique approach to soft tissue injury management. There is clinical evidence to support the use of CETE in the management of a number of wound types, including fasciotomy, trauma, amputation, and flap donor sites. The device can be applied to open wounds, potentially avoiding the need for a skin graft or other more complex or invasive reconstruction options. DermaClose applies constant tension without restricting blood flow and does not require repeated tightening. Critical Issues: CETE is becoming more widely used by surgeons of different specialties, and numerous reports describing its efficacy and safety in wound management have been published. Surgeons using CETE must follow the correct technique and select patients carefully to achieve optimal outcomes. However, there is no single source of information or consensus recommendations regarding CETE application. Future Directions: Prospective evidence on the efficacy and safety of CETE in clinical practice is required to communicate the best techniques and share important experiences. This will help to solidify its place in the reconstructive ladder as a valuable additional option for surgeons.

Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

“…In a separate report, Huh and Parekh 14 used a continuous external tissue expansion device after TAR-AA, a product that has also been used for large soft tissue wound management. 17,26 This device has external hooks placed on in the skin either side of the incision and connects them with a shoestring-like cable under tension. They reported decreased wound complication rates in 35 patients with this device, although no quantitative evidence was provided.…”

“…This study cohort is larger than previously published studies with similar methods (using other products) and duration of follow up. 17,18,23,28…”

“…This study cohort is larger than previously published studies with similar methods (using other products) and duration of follow up. 17,18,23,28 The primary limitations of the study are in its study design. Although a randomized prospective study would be more ideal because it can adjust for confounders such as surgeon experience, implant choice, and standardize suture closure technique, the current study comparing consecutively treated patients by the same surgeons does indicate a potentially clinically significant difference in outcomes with and without NSESs.…”

Management of Large Pediatric Wound Defects Using a Continuous External Tissue Expander

“…The device’s intrinsic mechanism prevents overtightening and maintains tension at 11.7 Newton (1.2 kg). 2 The device was tightened to the maximum allowed tension in all instances. If the wound was edematous, measures such as extremity elevation and ACE wrapping were applied.…”

Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates

“…Therefore, surgeons have long been searching for a practical, simple and effective method to achieve wound closure while maintaining aesthetics. The external tissue expansion technique may be a new choice for the reconstruction of skin soft tissue defects with the benefits of simplicity and minimal invasiveness [ 4 ].…”