Presentation on theme: "DermaClose® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re-approximating wounds "— Presentation transcript:
1DermaClose® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re-approximating wounds
2Overview An alternative to: Can assist with: Split Thickness Skin GraftsLocal, Regional and Free FlapsProlonged Secondary HealingCan assist with:Donor Site ClosureDelayed Primary ClosureWound Size Reduction
3Potential UsesCan be used to reduce the size of a wound intra-operatively.Facilitates delayed primary closure (usually within a few days)May be useful as a dynamic bolster to reduce amount of tension on suture line.
5Method of ActionElastin & Collagen in tight bundles within Dermis surrounding the wound
6Plastic Deformation Method of Action Tension applied by skin anchors realigns the Collagen and Elastin fibers longitudinallyStress Relaxation of Collagen and ElastinFibers remain elongated after tension is removed
7Benefits Safe and Effective Easy to apply and remove No need to readjust or retighten, once setControlled and constant pulling forceHas been shown to facilitate 86% wound area reduction in an average of three daysCan be used on multiple wound shapes and sizes
8Preparation Preparation: Surgical undermining is strongly suggested to create a plane for tissue movement.The degree of undermining is determined by the surgeon based on co- morbidities and other factors.
9Application Insert Skin Anchors into the Skin Step One :Insert Skin Anchors into the Skin1cm – 3cm from the wound edge.It may be helpful to pre-mark the locations with a marker
10Application Secure Anchor with Two Skin Staples Step Two : The enclosed 3M Skin Stapler has a two stage mechanism. This allows you to position the staple and then squeeze fully to apply the staple across the skin anchor and into the skin.
11ApplicationStep Two :Secure Anchor with Two Skin Staples
12Application Skin Anchors should be placed 2 to 3 cm apart Step Three : 2cm – 3cm
13Application Press Tension control knob down and pull the line out Step Four :Press Tension control knob down and pull the line outIt may be helpful to press in and out on the blue knob
14DermaClose Application Step Five :Decide on Position of Tension Controller – Relative to the WoundLocallyRemotely
15DermaClose Application Step Five :If Tension Controller is to be placed RemotelyThread Tension Line into Bridge Tubing as Necessary
16DermaClose Application Step Six :Seat Tension Controller on ‘Home Anchor’Often at the widest part of the wound
17DermaClose Application Step Seven :Thread Tension Line under tab of off-set skin anchors moving from inside to outside of the anchors
18DermaClose Application Step Eight : Thread line around the outside and then back under the tab of the opposing anchors
19DermaClose Application Step Nine :Thread line back inside to the middle tab opposing the ‘Home Anchor’
20DermaClose Application Step Ten :Check Line Symmetry and ensure that there are no eyelets or loops around the anchors
21DermaClose Application Step Eleven : Turn Tension Control Knob Clockwise to Tighten After about ten full rotations an audible clicking will eventually be heard indicating that the pre-determined tension of 1.2kg has been reached
22DermaClose Application Step Twelve :Engage Lock ButtonDress Wound as Appropriate
24Plastic & Reconstructive Surgery Fasciotomy – Leg Crush Injury (Page 1 of 2)Before ApplicationIntra-OperativePatient sustained a crush injury to the lower leg. Compartment Syndrome resulted in a four compartment fasciotomyPost Application of the DermaClose with immediate reduction in wound size
25Plastic & Reconstructive Surgery Fasciotomy – Leg Crush Injury (Page 2 of 2)Day 4Day 4Patient returned for final wound closure on Day 4.The wound was successfully closed with skin glue, retention sutures and steri-strips
26Plastic & Reconstructive Surgery Fasciotomy – Gunshot Wound (Page 1 of 2)Intra-OperativeBefore ApplicationPatient 31yr old male sustained a gun-shot wound to left popliteal fossa. Further examination revealed that the patient had no palpable pulse in the left foot and required a vein graft. A four compartment fasciotomy was performed.After 48hrs Patient was moved to OR for closure of the fasciotomy sites. The medial was closed primarily but there was too much tension to close the lateral fasciotomy. A DermaClose RC was used with a shoelace technique.Images Courtesy of : A. B. Levitt MD
27Plastic & Reconstructive Surgery Fasciotomy – Gunshot Wound (Page 2 of 2)Day 3Day 3After three days, the patient returned to the OR and the dressings were removed. The tissue adjacent to the fasciotomy wound had expanded significantly and the wound edges had approximated.The patient had no complaints of pain with the device in place. The wound was closed using a 2-0 monofilament non-absorbable and the DermaClose RC device was removed.Images Courtesy of : AB Levitt MD
28Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Leg (Page 1 of 3)Day 1Day 1 – Left Medial Leg19 x 5.5 cmDay 1 – Right Medial Leg16 x 5 cmPatient 17yr old student suffered a cardiac arrest. Due to ischemia reperfusion injury he developed a bi-lateral lower extremity compartment syndrome with muscle necrosis. He underwent serial debridement for 8 weeks before closure could be attempted.The DermaClose RC Continuous External Tissue Expander (CETE) skin anchors were applied to the wound edges, approximately 2-3 cm apart and secured with skin staples.Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
29Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Leg (Page 2 of 3)Day 1 – Left Medial LegDay 6 – Left Medial Leg10.5 x 2 cmDay 1 – Right Medial LegDay 6 – Right Medial Leg13 x 2.5 cmThe distal and proximal aspect of the wounds were approximated and closed using sutures.The DermaClose Tension Controller was applied to each wound. Significant reduction in the wound area was achieved intra-operatively.After 6 Days the patient returned, the wound edges had approximated and the DermaClose devices were removed.Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
30Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Leg (Page 3 of 3)The Bilateral Leg wounds were closed primarily resulting in minimal amount of scarring due to closure at the original incision line.Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
31Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3)Day 1Day 1Day 1Left Dorsal ForearmDay 1 – Right Medial LegDay 1Left Dorsal ForearmRight Dorsal ForearmRight Dorsal ForearmThe patient, a 44 yr old male underwent a cervical laminectomy and foraminotomy fusion. The procedure was complicated by bilateral extensor compartment syndrome which required urgent Fasciotomy.The DermaClose CETE Device was applied to the fasciotomy wound in conjunction with NPWT.Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
32Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3)Day 1Day 1Left ForearmRight ForearmDermaClose CETE worked in conjunction with NPWT . DermaClose was able to expand the tissue adjacent to the wound without compromising the function of the NPWTImages Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
33Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Arm (Page 3 of 3)Day 4 – Left Dorsal ForearmMonth 3 – Left Dorsal ForearmDay 6 – Left Medial LegMonth 3 – Right Dorsal ForearmDay 7 – Right Dorsal ForearmLeft Forearm : On day four both the NPWT and the DermaClose device were removed and the wound was closed by delayed primary intentionRight Forearm : Day seven both the NPWT and the DermaClose were removed. A small area required STSG whilst the majority of the wound was closed by delayed primary closure.Three Month Follow Up :Left Forearm : Wound Completely HealedRight Forearm : Small wound remains as a result of poor graft take.Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
34Plastic & Reconstructive Surgery Reoccurring Tumor – Irradiated TissueDay 0 – Left HipDay 0 – Left Hip - Three devices usedLeft Hip: Pt. was seen by orthopedic oncologist for resection of reoccurring tumor. Plastic surgery was consulted for repair of the resulting 16 x 14cm defect.Post-application: Following extensive undermining three DermaClose devices were placed. After tensioning the wound measured approximately 4 x 10cm.Images Courtesy of : C. Johnson MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
35Plastic & Reconstructive Surgery Reoccurring Tumor – Irradiated TissueDay 6 – Wound re-approximatedDay 6 – Delayed primary closureDay 6: Without re-tightening of the devices the wound was re-approximated on day six and the patient returned to the OR.Delayed Closure: The wound was closed in the usual and customary fashion. The patient returned at two weeks for partial suture removable.Images Courtesy of : C. Johnson MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN
36Traumatic Tissue Loss Injury Rt LegRt LegBoat Propeller InjuryDay 1Day 414 y/o patient suffered injuries including amputation of left leg as a result of a boating accident.DermaClose was used for just seven days to approximate the margins and facilitate closure of his right leg.R LegDay 7Photos courtesy of Dr. Wadih Macksoud MD, Orthopedic Surgeon, Orlando, FL
37General Surgery Abdominal Closure Case (Page 1 of 3) 28 x 23 cm10 x 22 cm6 x 18 cmBefore ApplicationDay 1 – Pre – OpDay 1 – Post – Op48 hr Post – Op36yr old morbidly obese diabetic patient presented with incisional hernia in 2008 and was treated with a succession of mesh products that eventually became infected.NPWT was applied for 2 months prior to applying the DermaClose CETE device. Two devices were applied in a procedure lasting 1 hour. The patient returned after 48 hrsImages Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA
38General Surgery Abdominal Closure Case (Page 2 of 3) 3 x 6 cmBefore Application48 hr Post – Op Reapplication5 Days Post – Op5 Days Post – Op ReapplicationAt 48 hrs the wound was irrigated and the two DermaClose CETE devices were reapplied. Additional sutures were placed on the lateral edges.The dressing was removed 36 hours later and a single DermaClose device was applied to the much smaller wound.Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA
39General Surgery Abdominal Closure Case (Page 3 of 3) Day NineDay Nine – ClosureFour Month Follow-UpAfter a further four days the patient returned to the OR. It was possible to approximate the wound edges and suture closed.Four month follow up, a small wound of unknown origin had formed below the closed wound.Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA
40David Armstrong D.P.M., PhD. Diabetic FootSecond partial metatarsal resection and digital amputationAfter two months V.A.C. therapy failed to close the wound7 days after applicationDavid Armstrong D.P.M., PhD.
41David Armstrong D.P.M., PhD. Diabetic FootSecond partial metatarsal resection and digital amputationDermaClose instrumental in limb salvage caseThree weeks post DermaClose RC applicationA separate device was used on the plantar surfaceDavid Armstrong D.P.M., PhD.
42Chronic Achilles Wound Pre-op photo of Achilles wound after 2 months wound management by Dr. Hanft. The wound was open for more than a year.Photo 15 minutes after application of the DermaClose. The device was left in place for 24 hours.One week post application of the DermaClose.Jason Hanft D.P.M.
43Squamous cell carcinoma Mohs SurgerySquamous cell carcinoma5.3 x 4.4 cm defectDay 1Day 12 x 1.5 cm24 hours laterEight week follow-upJane Lisko M.D.
44Atypical fibroxanthoma of the vertex scalp Mohs SurgeryAtypical fibroxanthoma of the vertex scalpDay 1Day 13 x 3 cm defectPost-applicationDay 25.25 cm scarDay 14Approximated marginsTwo week follow-upJeffery Samuel son M.D.
45Trichilemmal cystic carcinoma (wound reduction case) Mohs SurgeryTrichilemmal cystic carcinoma (wound reduction case)Courtesy of Amir A. Bajoghli, MD, George Washington University24 hours later6.3 X 5.8 cm defect post-op65 year old male underwent Mohs micrographic surgery which cleared the tumor in 3 stages. The DermaClose was left in place 24 hours. The resulting 1.0 x 3.0 cm healed nicely by secondary intention.Two week follow-upEight week follow-up