title: Intraoperative and delayed wound approximation in closure of skin defects in different areas.
abstract: OBJECTIVE
  Wound approximation device is an interesting reconstructive option but not well popularised. In this study we present a simple device that can be used for immediate or delayed closure of large dermal wounds in different anatomical areas.
  
  
  METHODS
  Patients with acute and chronic wounds were recruited and underwent immediate intra-operative wound approximation and/or delayed wound approximation, with a home-made wound approximation device.
  
  
  RESULTS
  Approximation time in the immediate closure group ranged from 20-140 minutes. Satisfactory scars were obtained in 19 patients (76%) and adherent scars developed in 6 patients. Delayed wound approximation was used successfully in closure of 9 defects.
  
  
  CONCLUSIONS
  This simple dermal wound approximation device can be used intraoperatively to successfully close large difficult wounds, located on the trunk and thigh, with minimal complications. The device can also be used to approximate delayed wounds located in regions where closure is particularly problematic, like the lower leg, foot, and scalp. Some modifications of the device are needed to improve its safety and efficacy. Wound tension is detrimental to adequate wound healing and tensile strength, another basic principle that should not be overlooked to avoid wound dehiscence. Wound approximation is adding to reconstructive options, not replacing them, and they must always be considered.
authors.affiliation: Associate Professor of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
authors.forename: Y A
authors.initials: YA
authors.lastname: Aboelatta
authors.affiliation: Elhelmia Military Hospital.
authors.forename: A
authors.initials: A
authors.lastname: Elshahm
authors.affiliation: Associate Professor of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
authors.forename: M A
authors.initials: MA
authors.lastname: Saleh
authors.affiliation: Associate Professor of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
authors.forename: I H
authors.initials: IH
authors.lastname: Kamel
authors.affiliation: Department of Plastic and Reconstructive Surgery, Saint John Hospital, Saint John, NB, Canada.
authors.forename: H M
authors.initials: HM
authors.lastname: Aly
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation*; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D017695:Soft Tissue Injuries / Q000601:surgery*; D013718:Tensile Strength; D058106:Wound Closure Techniques / Q000295:instrumentation*; D014945:Wound Healing; D055815:Young Adult
keywords: chronic wounds; defect reconstruction; external skin expansion; skin stretching; wound approximation