Pediatric Wound Closure by a Tension-Relief System
Dafna Shilo Yaacobi1, Moris Topaz2, Eyal Kalish1,3
1Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
The TopClosure Tension-Relief System offers a modified, skin-sparing approach for secure primary wound closure in pediatric patients. This innovative technique successfully managed large defects, avoiding scars and improving outcomes.
Area of Science:
- Pediatric Surgery
- Wound Healing
- Dermatology
Background:
- Pediatric surgical reconstruction presents unique challenges, often necessitating complex wound closure strategies.
- Primary wound closure is ideal but frequently difficult for large defects in children.
- The TopClosure Tension-Relief System is an innovative skin-stretching device for wound closure.
Purpose of the Study:
- To evaluate the modified TopClosure Tension-Relief System for pediatric wound closure.
- To assess the safety, efficacy, and outcomes of this technique in a pediatric population.
- To report on the successful application of the system in managing challenging pediatric wounds.
Main Methods:
- A retrospective review of 112 pediatric patients (7 days to 18 years) from 2010-2020.
- Modified TopClosure Tension-Relief System fixation to a protective dressing, avoiding direct skin attachment.
- Inclusion of diverse cases: congenital deformities, trauma, burns, and complex wounds with exposed hardware or deep tissue.
Main Results:
- Successful primary closure of large pediatric wound defects was achieved in all cases.
- The modified technique avoided staple scars and patient pain.
- The system reduced the need for multiple surgeries and complex reconstructive flaps.
- Low complication rates and satisfactory aesthetic and functional results were observed.
Conclusions:
- The modified TopClosure Tension-Relief System is a safe and effective method for pediatric wound closure.
- This technique offers a valuable alternative for managing challenging tension wounds in children and adolescents.
- Early or immediate wound closure was successfully achieved, improving patient outcomes.
Abstract:
Surgical reconstruction in pediatric patients can often be complex. Primary wound closure is almost always the preferred technique in the reconstructive ladder; however, it is not always possible in pediatric patients. We report the pediatric use of the TopClosure Tension-Relief System, an innovative skin-stretching technique for secure primary wound closure of large defects. We modified the technique by fixating it to a protective dressing instead of the patient's skin, thus avoiding both staple scars and pain. A retrospective review of 112 patients aged 7 days to 18 years who underwent Tension-Relief System-assisted surgery at a tertiary medical center from 2010 to 2020 was conducted. Cases included congenital deformities, traumatic wounds, burn scars, and complicated-wounds, with or without hardware or deep tissue exposure. The use of the system avoided the need for multiple surgical sessions and for local or regional flaps. The technique was simple to use, with few complications, and led to satisfactory aesthetic and functional outcomes. The findings support using the technique in children and adolescents with challenging tension wounds. Herein, we report on our experience with the Tension-Relief System and detail four cases in which early or immediate closure was successfully achieved.
