A clinical trial of wound closure by constant tension approximation

BACKGROUND: Wounds that heal slowly may pass through a subacute phase and proceed to reach a chronic situation, The latter may heal slowly, if at all, These wounds often heal by secondary intention with a single layer of epithelium that has a tendency to break down, Methods that expedite healing by full-thickness skin usually involve operative procedures. A nonoperative method of achieving coverage of tardy wounds with full-thickness skin, partial or complete depending on the wound, would be valuable. PATIENTS AND METHODS: A device has been designed that approximates the wound margins by applying constant low-grade tension over a period of days or weeks, One or more devices have been applied to the wounds of 25 patients to date. RESULTS: Healing has been obtained in those patients (20) where the devices were used optimally, In 5 patients, optimal use was not possible, mostly for socioeconomic reasons; the latter included noncompliance, insurance problems, economic difficulties, and personal considerations, In these 5 cases, healing was obtained in the 3 that were available for follow-up, full-thick ness skin coverage being estimated by grid photography to be in the 80% to 90% range, One patient was lost to follow-up after the wound was 95% covered by full-thickness skin, One patient whose wound reduced in size declined further treatment after 12 days of treatment. CONCLUSIONS: If appears that when constant-tension, low-grade force is applied to subacute and chronic wounds, healing is accelerated and, depending on the wound, a considerable number of ulcers can be closed by full-thickness skin.