dermaclose ® rc is a continuous external tissue expander that facilitates rapid tissue movement,...

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


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


Step Six : Seat Tension Controller on ‘Home Anchor’ Often at the widest part of the wound


Step Seven : Thread Tension Line under tab of off-set skin anchors

moving from inside to outside of the anchors


Step Eight : Thread line around the outside and then back

under the tab of the opposing anchors


Step Nine : Thread line back

inside to the middle tab opposing the ‘Home Anchor’


Step Ten : Check Line Symmetry and ensure that there

are no eyelets or loops around the anchors


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


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


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


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


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


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)


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.






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.


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.



Left Dorsal Forearm

Left Dorsal Forearm

Right Dorsal Forearm

Day 1

Day 1

Day 1

Day 1

Right Dorsal Forearm


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


Left Forearm

Day 1 Day 1

Right Forearm

Fasciotomy – Compartment Syndrome - Arm (Page 1 of 3)


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)



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.


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


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


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



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)

dermaclose ® rc is a continuous external tissue expander that facilitates rapid tissue movement,...

Documents

wound slide

dermaclose application

necessary slide

appropriate slide

marker slide

skin staples slide

fasciotomy wound

home anchor slide