Multiple relaxing skin incisions in orthopaedic lower extremity trauma

The purpose of this study was to evaluate the efficacy of using multiple relaxing skin incisions (MRSIs) to facilitate the closure of difficult lower extremity wounds. Such wounds are caused by direct trauma or by surgical intervention for management of bone and soft tissue injury that result in wound closure under tension. Common alternatives include closure by secondary intention, delayed primary closure, split thickness skin grafting, or flap coverage. The technique of MRSI involves numerous small (5-10 mm) incisions through the dermis arranged in 1-cm-wide rows parallel to the primary wound or incision. Multiple relaxing skin incisions were utilized in 22 cases of orthopaedic lower extremity trauma to facilitate primary or delayed primary closure. Wounds were evaluated for dehiscence, skin slough, superficial and deep infection, and neurovascular compromise in the early postoperative period. Cosmesis was evaluated long term. Patients were followed postoperatively for > or = 1 year. There were no cases of wound dehiscence, skin slough, infection, or neurovascular compromise. Multiple relaxing skin incisions were preferred by all patients when compared to split thickness skin grafting, open wound management, or flap coverage. Cosmetic results were excellent. The use of MRSIs is a safe, simple, and reliable technique where wound closure is complicated by swelling due to trauma or soft tissue defects. No specialized training or equipment is required, and postoperative wound care is greatly simplified.