title: A substitute for skin grafts, flaps, or internal tissue expanders in scalp defects following tumor ablative surgery.
abstract: BACKGROUND
  The skin of the scalp is relatively thick, minimally mobile, with distinct hair distribution. TopClosure® is a novel device for skin stretching and secure wound closure.
  
  
  OBJECTIVE
  To evaluate the efficacy of the TopClosure® system in primary closure of moderate and large scalp defects, as a substitute for skin grafts, flaps, and tissue expanders.
  
  
  METHODS
  We report a retrospective series of 8 patients requiring resection of 9 scalp tumors resulting with moderate to large size defects that otherwise would have required reconstruction with skin grafts, flaps, or tissue expanders. TopClosure® was applied for intraoperative cycles of stress-relaxation, followed, when indicated, by additional steps of mechanical creep and scar secure.
  
  
  RESULTS
  Skin defects, averaging 3.5 cm, were managed by TopClosure®, enabling, primary closure in all wounds. Immediate wound edge approximation was reached through stress-relaxation in 2 wounds by heavy tension sutures within one hour. Further skin stretching by mechanical creep was required in 7 wounds, achieving staged primary closure in an outpatient setting. TopClosure® was further applied to secure the skin for up to 3 weeks following surgery.
  
  
  CONCLUSIONS
  The TopClosure system, effectively, aided closure of moderate and large scalp defects by stress-relaxation and mechanical creep and serving as a topical tension-relief platform for tension sutures, allowing mobilization of skin and subcutaneous tissue without undermining or need of drainage, for early, direct wound closure. Local complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced, and post-operative wound aesthetics were improved.
authors.forename: Moris
authors.initials: M
authors.lastname: Topaz
authors.forename: Narin-Nard
authors.initials: NN
authors.lastname: Carmel
authors.forename: Guy
authors.initials: G
authors.lastname: Topaz
authors.forename: Isaac
authors.initials: I
authors.lastname: Zilinsky
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012536:Scalp Dermatoses / Q000209:etiology / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D012879:Skin Physiological Phenomena; D016038:Skin Transplantation; D040521:Subcutaneous Tissue / Q000502:physiology; D013524:Surgical Flaps; D013537:Sutures; D014006:Tinea Capitis / Q000601:surgery; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery