A method of controlled closure: the use of Ligaclips in the delayed primary closure of flaps

BACKGROUND AND PURPOSES OF THE STUDY: Achieving primary closure of a flap may not always be possible initially. Current controlled closure techniques exert uniform pressure across a wound, which is unsuitable for a flap, as it can induce ischaemia in vulnerable areas. Using Ligaclips (Ethicon Inc., Somerville, NJ, USA) to secure tissue advancement along mattress sutures offers both the ease of expansion, like running sutures, and the ability to moderate tension in discrete areas, like interrupted sutures. The two cases here highlight variations of how this technique can be applied to close wounds boarded by vulnerable tissues such as flaps. We conclude that the use of Ligaclips in conjunction with mattress sutures in the controlled closure of defects around flaps is simple and fast, enabling greater control over the forces exerted over discrete areas, minimising the risk of compromising vulnerable tissues.