A new method for applying constant tension approximation to a large wound deficit

The closure of large wound deficits is a great challenge to clinicians. Employment of constant tension approximation (CTA) to take advantage of the viscoelastic properties of soft tissue has been successful with invasively implanted pins1-3. Researchers report that CTA acts by stimulating angiogenesis and epithelial proliferation4. A new method* for the application of CTA is presented.

A 52-year-old female with a 30 year history of rheumatoid arthritis underwent removal of infected total hip replacement hardware with subsequent implantation of cadaver bone. An 18.5 X 5 cm. wound deficit resulted which measured 7.5 X 2.5 cm after nine months of negative pressure therapy (NPT). Six additional weeks of NPT yielded no further changes.

A subsequent treatment regimen applied CTA to the wound margins using a new composite dressing with stretch. Dead wound space was filled with a topical absorptive product. Within six weeks, wound size decreased by 36% to 6.0 X 2.0 cm, and epithelialization was present at margins. During CTA therapy, the patient denied pain and adverse effects while reporting improved quality of life.

A new non-invasive and cost-effective method of CTA improved wound closure in this case after negative pressure therapy was no longer effective. Further study is warranted.

*DP Wound Dressing TM from Graham® Professional Medical Products, Green Bay, WI.

1. Hirshowitz, B, Lindenbaum, E, Har-Shai, Y. A skin-stretching device for the harnessing of the viscoelastic properties of the skin. Plast Reconstr Surg 1996;3:747-8.
2. Ger, R. The use of external tissue expansion in the management of wounds and ulcers. Ann Plast Surg 1997;4:352-7.
3. Ersek, RA, Vazquez-Salisbury A. Wound closure using a skin stretching device. Contemp Orthop 1994;6:495-500.
4. Ger, R. Wound management by constant tension approximation.Ostomy Wound Management 1996:40-6.

Published Study: Motta, G., Milne, C. Treating wound deficit using constant tension to approximate wound margins: Ostomy /Wound Management , 2004; 50(2): 22-23.

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