Wound modulation via sclerotherapy and tissue adhesion. Observations and discussion

Fluid accumulation in a 'dead space' after surgery or trauma predisposes the area involved to delayed healing. The fluid may promote inflammatory mediators and other wound-modulating factors, which encourages the continued existence of the dead space. Tissue adhesion by means of agents such as tetracyclines has long been described. With this concept, tissue adhesion has been accomplished with varying success in diverse clinical situations involving non-healing wounds and prophylactically in seroma-prone areas. A total of 69 patients were treated and monitored. The most impressive response to tetracycline tissue adhesion in this study was seen in intra-oral sites, with rapid closure of wounds. More complex wounds such as orocutaneous fistulas or wounds of a more chronic nature such as pressure sores did respond but took longer to resolve. The lateral thigh was found to be the most difficult and unresponsive area to treat (particularly after delayed presentation). Successful prophylactic use of tetracycline in seroma-prone areas (latissimus dorsi/parascapular flaps, etc.) is also described.