Management of Complex Wounds Using a Constant Tension External Tissue Expander

Overview

Complex wounds that cannot be closed primarily are at great risk for complications. A new technique utilizing external tissue expansion holds promise in rapidly decreasing wound area. Facilitation of rapid wound closure is critical in preventing wound complications. Hypothesis: Using the Dermaclose Wound Management System (Woundcare Technologies, Inc., Chanhassen, MN) in complex wounds not able to be primarily closed will decrease the time to secondary closure and decrease the need for secondary soft tissue coverage procedures, or if secondary soft tissue procedures are required, its use will decrease the size and complexity of the secondary soft tissue procedures. Null Hypothesis: The Dermaclose system will not decrease the need, dimensions, or complexity of secondary soft tissue coverage procedures in complex wounds not able to be primarily closed.

Upon IRB approval, 50 patients with complex soft tissue wounds, with or without an associated fracture that cannot be closed primarily will have the Dermaclose device applied and will be prospectively followed for 1 year. The Dermaclose device will be applied according to the manufacturer's guidelines. This device may be combined with the use of Negative Pressure Wound Therapy. Primary and secondary end points that were initially intended to be included are listed below. However, on SF12 and pain outcome measures were collected and reported. Initially Intended Primary end points (only SF12 collected and reported): SF12 1. Initial and final wound dimensions 2. Secondary soft tissue coverage procedures 3. Dimensions and type of secondary soft tissue coverage procedures required compared to initial wound dimensions 4. Method of wound closure 5. Days to wound closure 6. Number and types of procedures required for wound closure 7. Infection requiring reoperation 8. Wound dehiscence requiring reoperation Initially intended Secondary end points (only #3 collected and reported): 1. Superficial wound dehiscence not requiring reoperation 2. Superficial wound infection not requiring reoperation 3. Visual Analog Pain Scale (VAS) with Dermaclose use 4. Use of negative pressure wound therapy 5. Cost-to-benefit ratio of Dermaclose use - hospital days, number of procedures, procedural and hospital costs including device, negative pressure wound therapy costs, and operating room time and associated costs Patients will be evaluated daily during their inpatient hospital stays for VAS related to the wound for which the Dermaclose device is used. If the Dermaclose device is used on an outpatient basis, the patient will be asked to complete a daily VAS at the same time to monitor pain associated with device use. After hospital discharge, the patients will be evaluated at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months. They will complete an SF-12 as part of the above evaluations. Patients may be evaluated at more frequent intervals if the need arises. Primary and secondary endpoints will be evaluated at each time point.