Progressive Tightening of Pulley Sutures for Primary Repair of Large Scalp Wounds

Abstract

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Synergistic Effect of Chitosan and Selenium Nanoparticles on Biodegradation and Antibacterial Properties of Collagenous Scaffolds Designed for Infected Burn Wounds

“…Minor skin wounds follow the healing process of homeostasis, inflammation, proliferation, and matrix deposition with the remodeling of the tissue as the final result [ 2 ]. However, severely infected wounds larger than 2 cm in diameter follow a slower and more complicated repair process and often fail closure [ 3 , 4 , 5 ]. Opportunistic skin bacteria from the genus Staphylococcus are a common source of infection, namely, Staphylococcus aureus or Staphylococcus epidermidis [ 6 , 7 ].…”

Preservation of hair density and orientation in a large scalp defect of a female patient using a novel intraoperative skin relaxation device

“…Some surgeons employ a central far-near-near-far (pulley) suture to achieve a similar relaxation as with the ISR technique. However, use of a pulley suture for closure of scalp wounds >2 cm in width is prone to wound edge necrosis ( Malone et al, 2017 ). The ISR disperses pressure away from the wound edge to prevent skin tearing ( Lear et al, 2019 ).…”

A novel suture retention device for intraoperative tissue support

“…If a surgeon attempts linear closure, the force on the central suture often exceeds the strength of the dermis and the suture tears through the tissue. Towel clamps and pulley sutures may be used, but these techniques can be damaging to tissue 2, 3…”

“…This increases the mechanical advantage of the suture and can be gradually tightened to allow for intraoperative tissue expansion 8 . Unfortunately, this technique requires 4 puncture wounds and places tension on the epidermis, which can result in excessive scarring 2, 8, 9…”

“…Options are limited if a patient requests closure but declines a larger flap or graft procedure. Towel clamps and pulley sutures can be used to stretch the skin and redistribute tension but can be very damaging to tissue 2, 3. We previously described a promising technique of intraoperative tissue expansion using a suture retention device (SRD) (SUTUREGARD, SUTUREGARD Medical, Portland, OR) 4, 5.…”