dermaclose ® rc is a continuous external tissue expander that facilitates rapid tissue movement,...
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DermaClose® RC is a continuous external tissue expander that facilitates rapid tissue movement, reducing or re-approximating wounds
Overview
An alternative to: Split Thickness Skin Grafts Local, Regional and Free Flaps Prolonged Secondary Healing
Can assist with: Donor Site Closure Delayed Primary Closure Wound Size Reduction
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.
Method of Action
Method of Action
Elastin & Collagen in tight bundles within Dermis surrounding the wound
Tension applied by skin anchors realigns the Collagen and Elastin fibers longitudinally
Stress Relaxation of Collagen and ElastinFibers remain elongated after tension is
removed
Method of Action
Plastic Deformation
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
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.
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
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.
Application
Step Two : Secure Anchor
with Two Skin Staples
Application
Step Three : Skin Anchors
should be placed 2 to 3 cm apart
2cm – 3cm
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
DermaClose Application
Step Five : Decide on Position of Tension Controller –
Relative to the Wound
Locally Remotely
DermaClose Application
Step Five : If Tension Controller is to be placed Remotely Thread Tension Line into Bridge Tubing as Necessary
DermaClose Application
Step Six : Seat Tension Controller on ‘Home Anchor’ Often at the widest part of the wound
DermaClose Application
Step Seven : Thread Tension Line under tab of off-set skin anchors
moving from inside to outside of the anchors
DermaClose Application
Step Eight : Thread line around the outside and then back
under the tab of the opposing anchors
DermaClose Application
Step Nine : Thread line back
inside to the middle tab opposing the ‘Home Anchor’
DermaClose Application
Step Ten : Check Line Symmetry and ensure that there
are no eyelets or loops around the anchors
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
DermaClose Application
Step Twelve : Engage Lock Button Dress Wound as Appropriate
Clinical Cases
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
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 Day 4
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
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 Day 3
Images Courtesy of : AB Levitt MD
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)
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)
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
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
Left Dorsal Forearm
Right Dorsal Forearm
Day 1
Day 1
Day 1
Day 1
Right Dorsal Forearm
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 Day 1
Right Forearm
Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3)
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 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 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
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.
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-approximated
Day 6 – Delayed primary closure
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
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 – Op Day 1 – Post – Op 48 hr Post – Op
28 x 23 cm 10 x 22 cm 6 x 18 cm
Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA
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 – Op 5 Days Post – Op Reapplication
3 x 6 cm
Images Courtesy of : H L Tuten MD, Dept. of Surgery. New Iberia LA
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)
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
DermaClose instrumental in limb salvage case
Three weeks post DermaClose RC application
Second partial metatarsal resection and digital amputationDiabetic Foot
David Armstrong D.P.M., PhD.
A separate device was used on the plantar surface
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
Day 1 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
3 x 3 cm defect
Approximated margins
Post-application
Two week follow-up
Day 1
Day 14Day 2 5.25 cm scar
Atypical fibroxanthoma of the vertex scalpMohs Surgery
Day 1
Jeffery Samuel son M.D.
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 SurgeryTrichilemmal cystic carcinoma (wound reduction
case)
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