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Michael Bell, MD, FRCSC

For the simple open wound, there are numerous advertised closure products on the market. Many patients with open wounds that present closure difficulties have co-morbidities, traditionally contraindicating a primary closure attempt.

Skin breached by an incision or traumatic disruption, will retract. The wound margins become edematous and the margins stabilize in their new retracted position creating a permanent fixed defect. The forces required to close such a wound increase to a point where the required static closure force itself becomes traumatic to the soft tissue and the less desirable secondary closure remains the only practical option.

Attempts to maintain the primary closure option utilizing elastic traction have been reported by surgeons, using the materials on-hand. Fasciotomies, for example, have been conventionally treated with vessel loops and staples, but success is somewhat variable. Alternatively, fasciotomies are treated with wound suctioning for 1-2 weeks until a healthy granulation bed is formed, then skin grafted, creating a second defect at the donor site. Wound suctioning for an additional 5-7 days follows. There is, of course, a prolonged period of bed rest for these patients and ongoing homecare is frequently required.

Recently, surgeons have reported encouraging results using commercially available elastic traction devices (ABRA Dynamic Wound Closure, www.canica.com). When elastic traction is employed early to offset the natural retracting forces of the wound, a delayed primary closure remains a predictable outcome. By simply applying a low elastic traction force, the retractive characteristics of skin are reversed and the viscoelasticity of skin regained, permitting a low-tension primary closure of the defect. In most cases the patient can remain mobile during treatment.

A recent case series in the Netherlands reported a 100 percent primary closure rate of extremity fasciotomies in an average of 6.3 days, using topically applied ABRA Adhesive Skin Closure (http://www.canica.com/adhesiveanchor.asp). An earlier study conducted by military surgeons in Iraq utilized ABRA Surgical Skin Closure (http://www.canica.com/skinanchor.asp) to close fasciotomies, and reported all but one patient was primary closed in an average of 2.6 days.
These devices are simply a revolution in restoring the primary closure option in open wounds. Even the most challenging of defects can usually be managed.

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