Small- to medium-sized ulcers and wounds that are “difficult-to-close” constitute the bulk of wounds that cause problems in closure. Direct suture is the best-known option to treat wounds, but all wounds are not amenable for it. Such problem wounds require treatment techniques such as skin grafting and flap coverage. An external fixator, called “Joshi’s external stabilization system,” was used in this technique. Two Kirschner wires were attached to two specialized adjustable screws, called “distracters,” to construct the external fixator. One Kirschner wire each was passed intradermally on either side of a wound, and their ends were connected by the specialized screws, called the distracters. The knobs of these distracters were turned at regular intervals. With turning of the knobs each time, the Kirschner wires moved toward each other and brought the wound edges along with them. When the wound’s edges met each other, the wounds were closed with sutures, and the external fixator was removed. This technique was applied for 16 patients, for defects of 2.5–10 cm size, from head to foot, over a 3-year period, from January, 2008 to December, 2010. There were 11 male and five female patients, between ages 5 and 93 years. Treatment duration ranged from 10 to 28 days, and follow-up was from 3 to 24 months. This technique was found useful to attain direct closure of chronic ulcers and difficult-to-close wounds and obviate the need for, and render superior results compared to, skin grafting and flap coverage.
European Journal of Plastic Surgery – Springer Journals
Published: Apr 1, 2012
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