[Dynamic skin suture for secondary skin closure and treatment of skin defects]

Dynamic skin suture exerts progressive traction to the wound margins which allows a stepwise closure of a defect. It consists of interrupted sutures with two additional plastic tubes lying parallel to the wound margins on the surface of the skin. The extracuticular slopes of the sutures and the knots pass over these tubes. This decreases local pressure on the skin. The knots are performed in a way that, once they have been tied, permits further tightening without opening them. A viscoelastic property of the skin--stress-relaxation- reduces the tension on the sutures over time and allows a further tightening. As an example for the use of this technique, the results of closures of fasciotomies in compartment syndromes are presented. In 1993, 50 fasciotomies in 35 patients were treated with dynamic suture. In 42 defects (84%) a complete obliteration was possible. In the residual 8 defects reduction of size was significant. The mean time until obliteration was 11.5 days, in average sutures were tightened 4 times. The results suggest that dynamic suture is a useful technique for repair in fasciotomies. It helps avoiding tissue transplantations. The operative procedure itself is speedy and simple. Possible indications in limited excisional defects are demonstrated in a case report.