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DermaClose ® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re- approximating wounds DermaClose ® RC is.

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Presentation on theme: "DermaClose ® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re- approximating wounds DermaClose ® RC is."— Presentation transcript:

1 DermaClose ® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re- approximating wounds DermaClose ® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re- approximating wounds

2 Overview An alternative to: An alternative to: Split Thickness Skin Grafts Local, Regional and Free Flaps Prolonged Secondary Healing Can assist with: Can assist with: Donor Site Closure Delayed Primary Closure Wound Size Reduction

3 Potential Uses Can 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.

4 Method of Action

5 Elastin & Collagen in tight bundles within Dermis surrounding the wound

6 Tension applied by skin anchors realigns the Collagen and Elastin fibers longitudinally Stress Relaxation of Collagen and Elastin Fibers remain elongated after tension is removed Method of Action Plastic Deformation

7 Benefits Safe and Effective Easy to apply and remove No need to readjust or retighten, once set Controlled and constant pulling force Has been shown to facilitate 86% wound area reduction in an average of three days Can be used on multiple wound shapes and sizes

8 Preparation 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.

9 Application Step One : Insert Skin Anchors into the Skin 1cm – 3cm from the wound edge. It may be helpful to pre-mark the locations with a marker

10 Application Step Two : Secure Anchor with Two Skin Staples 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.

11 Application Step Two : Secure Anchor with Two Skin Staples

12 Application Step Three : Skin Anchors should be placed 2 to 3 cm apart 2cm – 3cm

13 Application Step Four : Press Tension control knob down and pull the line out It may be helpful to press in and out on the blue knob

14 DermaClose Application Step Five : Decide on Position of Tension Controller – Relative to the Wound Locally Remotely

15 DermaClose Application Step Five : If Tension Controller is to be placed Remotely Thread Tension Line into Bridge Tubing as Necessary

16 DermaClose Application Step Six : Seat Tension Controller on Home Anchor Often at the widest part of the wound

17 DermaClose Application Step Seven : Thread Tension Line under tab of off-set skin anchors moving from inside to outside of the anchors

18 DermaClose Application Step Eight : Thread line around the outside and then back under the tab of the opposing anchors

19 DermaClose Application Step Nine : Thread line back inside to the middle tab opposing the Home Anchor

20 DermaClose Application Step Ten : Check Line Symmetry and ensure that there are no eyelets or loops around the anchors

21 DermaClose 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

22 DermaClose Application Step Twelve : Engage Lock Button Dress Wound as Appropriate

23 Clinical Cases

24 Plastic & Reconstructive Surgery Fasciotomy – Leg Crush Injury (Page 1 of 2) Patient sustained a crush injury to the lower leg. Compartment Syndrome resulted in a four compartment fasciotomy Post Application of the DermaClose with immediate reduction in wound size Before Application Intra-Operative

25 Plastic & Reconstructive Surgery Fasciotomy – Leg Crush Injury (Page 2 of 2) Patient returned for final wound closure on Day 4. The wound was successfully closed with skin glue, retention sutures and steri-strips Day 4

26 Intra-Operative Plastic & Reconstructive Surgery Fasciotomy – Gunshot Wound (Page 1 of 2) Patient 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. Before Application Images Courtesy of : A. B. Levitt MD

27 Plastic & Reconstructive Surgery Fasciotomy – Gunshot Wound (Page 2 of 2) After 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. Day 3 Images Courtesy of : AB Levitt MD

28 Plastic & Reconstructive Surgery Patient 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. Day 1 Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN Day 1 – Left Medial Leg Day 1 – Right Medial Leg 16 x 5 cm 19 x 5.5 cm Fasciotomy – Compartment Syndrome - Leg (Page 1 of 3)

29 Plastic & Reconstructive Surgery The 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 Day 1 – Left Medial Leg Day 1 – Right Medial Leg Day 6 – Left Medial Leg Day 6 – Right Medial Leg 10.5 x 2 cm 13 x 2.5 cm Fasciotomy – Compartment Syndrome - Leg (Page 2 of 3)

30 Plastic & 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

31 Plastic & Reconstructive Surgery Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3) The 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 Day 1 – Right Medial Leg Left Dorsal Forearm Right Dorsal Forearm Day 1 Right Dorsal Forearm

32 Plastic & Reconstructive Surgery DermaClose CETE worked in conjunction with NPWT. DermaClose was able to expand the tissue adjacent to the wound without compromising the function of the NPWT Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN Left Forearm Day 1 Right Forearm Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3)

33 Plastic & Reconstructive Surgery Left Forearm : On day four both the NPWT and the DermaClose device were removed and the wound was closed by delayed primary intention Right 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 Healed Right Forearm : Small wound remains as a result of poor graft take. Day 4 – Left Dorsal Forearm Day 6 – Left Medial Leg Day 7 – Right Dorsal Forearm Month 3 – Left Dorsal Forearm Month 3 – Right Dorsal Forearm Fasciotomy – Compartment Syndrome - Arm (Page 3 of 3) Images Courtesy of : B Carlsen MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN

34 Plastic & Reconstructive Surgery Left 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. Reoccurring Tumor – Irradiated Tissue Images Courtesy of : C. Johnson MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN Day 0 – Left Hip Day 0 – Left Hip - Three devices used Post-application: Following extensive undermining three DermaClose devices were placed. After tensioning the wound measured approximately 4 x 10cm.

35 Plastic & Reconstructive Surgery Day 6: Without re-tightening of the devices the wound was re- approximated on day six and the patient returned to the OR. Reoccurring Tumor – Irradiated Tissue Images Courtesy of : C. Johnson MD, Dept. of Plastic Surgery. Mayo Clinic, Rochester MN Delayed Closure: The wound was closed in the usual and customary fashion. The patient returned at two weeks for partial suture removable. Day 6 – Wound re-approximatedDay 6 – Delayed primary closure

36 Traumatic Tissue Loss Injury 14 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. Day 1 Day 7 Day 4 Photos courtesy of Dr. Wadih Macksoud MD, Orthopedic Surgeon, Orlando, FL Rt Leg R Leg Rt Leg Boat Propeller Injury

37 General Surgery Abdominal Closure Case (Page 1 of 3) 36yr 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 hrs Before Application Day 1 – Pre – OpDay 1 – Post – Op48 hr Post – Op 28 x 23 cm10 x 22 cm6 x 18 cm Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA

38 General Surgery Abdominal Closure Case (Page 2 of 3) At 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. Before Application 48 hr Post – Op Reapplication 5 Days Post – Op5 Days Post – Op Reapplication 3 x 6 cm Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA

39 General Surgery After 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. Day Nine Day Nine – Closure Four Month Follow-Up Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA Abdominal Closure Case (Page 3 of 3)

40 David Armstrong D.P.M., PhD. Second partial metatarsal resection and digital amputation After two months V.A.C. therapy failed to close the wound 7 days after application Diabetic Foot

41 DermaClose instrumental in limb salvage case Three weeks post DermaClose RC application Second partial metatarsal resection and digital amputation Diabetic Foot David Armstrong D.P.M., PhD. A separate device was used on the plantar surface

42 Photo 15 minutes after application of the DermaClose. The device was left in place for 24 hours. Pre-op photo of Achilles wound after 2 months wound management by Dr. Hanft. The wound was open for more than a year. One week post application of the DermaClose. Jason Hanft D.P.M. Chronic Achilles Wound

43 Day 1 24 hours later Eight week follow-up 5.3 x 4.4 cm defect 2 x 1.5 cm Mohs Surgery Jane Lisko M.D. Squamous cell carcinoma

44 3 x 3 cm defect Approximated margins Post-application Two week follow-up Day 1 Day 14 Day cm scar Atypical fibroxanthoma of the vertex scalp Mohs Surgery Day 1 Jeffery Samuel son M.D.

45 65 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. 6.3 X 5.8 cm defect post-op Two week follow-up Courtesy of Amir A. Bajoghli, MD, George Washington University 24 hours later Eight week follow-up Mohs Surgery Trichilemmal cystic carcinoma (wound reduction case)


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