title: Simple Skin-Stretching Device in Assisted Tension-Free Wound Closure.
abstract: BACKGROUND
  Numerous conventional wound reconstruction methods, such as wound undermining with direct suture, skin graft, and flap surgery, can be used to treat large wounds. The adequate undermining of the skin flaps of a wound is a commonly used technique for achieving the closure of large tension wounds; however, the use of tension to approximate and suture the skin flaps can cause ischemic marginal necrosis. The purpose of this study is to use elastic rubber bands to relieve the tension of direct wound closure for simultaneously minimizing the risks of wound dehiscence and wound edge ischemia that lead to necrosis.
  
  
  METHODS
  This retrospective study was conducted to evaluate our clinical experiences with 22 large wounds, which involved performing primary closures under a considerable amount of tension by using elastic rubber bands in a skin-stretching technique after a wide undermining procedure. Assessment of the results entailed complete wound healing and related complications.
  
  
  RESULTS
  All 22 wounds in our study showed fair to good results except for one. The mean success rate was approximately 95.45%.
  
  
  CONCLUSIONS
  The simple skin-stretching design enabled tension-free skin closure, which pulled the bilateral undermining skin flaps as bilateral fasciocutaneous advancement flaps. The skin-stretching technique was generally successful.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, Buddhist Tzu-Chi General Hospital; †Department of Surgery, Tzu-Chi University, Hualien; and ‡Department of Surgery, Division of Plastic Surgery, Buddhist Tzu-Chi Dalin General Hospital, Chiayi, Taiwan.
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Cheng
authors.forename: Jiunn-Tat
authors.initials: JT
authors.lastname: Lee
authors.forename: Honda
authors.initials: H
authors.lastname: Hsu
authors.forename: Meng-Si
authors.initials: MS
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000517:prevention & control; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing