Saving the failing wound.

The Department of Surgery, Division of Plastic Surgery, The Ottawa Hospital-Civic Campus, Ottawa, Ontario Correspondence and reprints: Dr Michael SG Bell, 402-1919 Riverside Drive, Ottawa, Ontario K1H 1A2. Telephone 613-739-5424, fax 613-739-7168, e-mail [email protected] When suturing thin skin under significant tension one runs a high risk of somewhat delayed wound healing and increased scarring (1,2). When superficial infection is superimposed upon this problem, the surgeon often stands helplessly by as the dissolving subcutaneous sutures gradually give way and the wound progressively separates. Systemic and topical antibiotics are very often of marginal benefit in arresting the whole process of separation, which seems to be more mechanical, with the inflamed thin skin opening as the remaining dissolving sutures become point-loaded and serially fail. The use of steri-strips or some other static tape is not particularly beneficial. The separated wound edges cannot be reapproximated even with serial reapplication of tape. The edge of the tape exposed to exudate from the wound often loosens and the adhesive tends to cause shear forces and blistering at the intact skin adhesive margin (3). At this point, traditional rescue efforts are usually abandoned and dressings are begun to clean the wound to facilitate closure by secondary intervention. The author has used an ingenious new dynamic skin tape called SutureSafe from Canica Design Inc, Canada, in dealing with problems of this sort with considerable benefit, as is shown in the accompanying photo sequence. This dynamic tape, when put on early, even in thin skin under some tension, relieves the forces that would tend to progressively open the wound. If separation begins to occur the wound is protected, such that progressive suture failure will not occur resulting in a complete dehiscence. In fact, a wound that is beginning to dehisce can actually be pulled back together by the dynamic forces of the DynaStretch Tape. This adhesive micropore tape is not reinforced as are steri-strips, and stretches with the compliant skin thereby avoiding blistering. The central silicone elastomer produces relentless gentle dynamic closure forces. One can see the wound through the transparent silicone elastomer to discern any underlying infectious process. Topical antibiotics can be used in the wound. In fact, we have used thin packing on occasion. This is removed as the wound closes. The tape is easily applied, and typically lasts from five to seven days. When used over a period of three or four weeks it salvages and allows primary wound healing even in the face of superficial infection.