Percutaneous Mesh Expansion: A Regenerative Wound Closure Alternative
| Autor: | Roger K. Khouri, Kimberly S. Khouri, Eufemiano Cardoso |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Percutaneous Skin Neoplasms Tissue Expansion Scars 030230 surgery Resection 03 medical and health sciences Cicatrix 0302 clinical medicine Skin Physiological Phenomena medicine Humans Minimally Invasive Surgical Procedures Regeneration Minimally invasive procedures Aged Retrospective Studies Aged 80 and over Wound Healing Scalp Sutures business.industry Wound Closure Techniques Middle Aged Mohs Surgery Surgery Wound Closure Technique Clinical question Head and Neck Neoplasms Needles 030220 oncology & carcinogenesis Wound closure medicine.symptom business Wound healing |
| Zdroj: | Plastic and reconstructive surgery. 141(2) |
| ISSN: | 1529-4242 |
| Popis: | Background Puncture wounds in the 1-mm range usually heal without scars. Stacking rows of these punctures offers a scarless method to generate tissue by mesh expansion. The authors developed a percutaneous mesh expansion procedure and present their experience for its wound closure application. Methods Over a 6-year period, the authors applied percutaneous mesh expansion to 65 consecutive patients aged 58 to 101 years (mean, 72 years) with 67 full-thickness calvarial defects ranging in size from 2.5 × 3 cm to 7 × 8 cm (mean, 14 cm) that would have all required flaps for closure. Thirty-six were still anticoagulated, and 20 had prior scalp resections. After tumescent epinephrine anesthesia, the authors temporarily approximate the wound by placing it under strong tension. Using 1.1-mm cutting point needles that selectively sever tissues under tension, the authors inflict rows of staggered alternating punctures over a distance five times the defect width. This results in 20 percent expansion of the meshed area, generating the tissue necessary for defect coverage. When the tension is completely released, closure is performed with simple sutures or staples. The authors avoid overmeshing, especially close to the wound edges, and perform no undermining or additional incisions. Results At 6-week follow-up, all defects were healed with only a straight resection scar. However, of the 10 defects larger than 5 × 5 cm, five had wound healing delay and three required a small skin graft. No other complication was observed. Conclusions Percutaneous mesh expansion is a minimally invasive procedure that harnesses the body's natural capabilities to regenerate across small gaps. It sums these regenerated gaps in a mesh pattern that expands tissues to close complex wounds without flaps or additional incisions. Clinical question/level of evidence Therapeutic, IV. |
| Databáze: | OpenAIRE |
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