Advances in Wound Closure Technologies - Optimizing the Closure of infected Amputation Wounds

Primary Wound closure of amputated limbs is crucial for better functionality and early ambulation. Wound infection and high tension closure restrict wound edge approximation delay wound healing and results in impaired functionality. Simultaneous administration of supplemental oxygen and wound irrigation as in Regulated Oxygen-Enriched and Irrigation Negative Pressure-Assisted Wound Therapy (ROI-NPT) was applied to synergistically combat anaerobic infection, reduce wound’s bacterial load and promote wound healing.

The TopClosure^® Tension Relief System (TRS) is a novel device for wound stretching, closure and secure. It applies controlled, incremental, and evenly-distributed tension relief, over a wide area of attachment away from wound margins. The TopClosure^® TRS attaches to the skin both invasively and noninvasively, in a dynamic, adjustable, reversible, zipper-like manner allowing skin stretching by both mechanical creep and stress relaxation.

We present a series of 4 patients infected limb amputation due to diabetes, peripheral vascular daisies and trauma, and one patient with fasciotomy, where both ROI-NPT and TRS were applied for early resolution of infection and primary closure of the stump, substituting for skin grafts or flaps with improved fitting of prosthetics and better functionality.

The combination of TRS and ROI-NPT alters the three phases of wound healing by reducing inflammation, eliminating the need for lengthy proliferation of granulation tissue, reaching early maturation and enabling improved functionality. This unique synergistic effect provides a totally new concept of wound management that changes perceptions of infected amputation wound closure, and instituting new standards of care for optimizing wound healing and functionality.