Tension Relief System, Combined With Regulated Oxygen and Irrigation Negative Pressure-Assisted Wound Treatment - A Novel Damage Control Approach for Soft Tissue Injury

Introduction: Extensive surgical experience in the treatment of wounds in combat and disaster has led to the adoption of strict management principles in the treatment of soft tissue injury. These include cleansing, debridement, removal of foreign bodies, and most important, leaving the wounds open. Large wounds are commonly managed preliminary by vacuum to enhance granulation tissue growth with subsequent coverage with skin grafts or flaps. Treatment is usually lengthy, commonly complicated by infection and donor site morbidity.

Objective: To evaluate feasibility and safety of an alternative approach which incorporates cleansing, debridement, immediate skin stretching with TopClosure® tension relief system (TRS), wound oxygenation and irrigation, for early primary wound closure.

Methods: ound closure sequence and modes include: 1. Cleansing, removal of foreign bodies and conservative debridement. 2. Immediate staged stretching and mobilization of wound edges by the TRS. 3. Early application of vacuum combined with wound oxygenation and irrigation. 4. Primary wound closure once the infection is controlled. 5. Quick ambulation and rehabilitation.

Preliminary clinical cases will be presented.

Results: Early wound decontamination and skin stretching facilitated quick primary closure of even large soft tissue defects. Heavily infected wounds were closed gradually but even in these cases, wounds could be closed primarily by the TRS without the need for granulation tissue to form. In most cases, skin grafts and flaps were avoided allowing quick ambulation and rehabilitation.

Conclusion: This novel approach practically allows for closure of wounds in two stages skipping the customary, lengthy second phase of granulation tissue growth in the wound healing process by direct stretching of wound edges through the TopClosure® system, substituting for skin graft and flaps. This technique downgrades surgical complexity and morbidity, substantially shortens hospitalization, reduces scaring with improved functionality. The workload is reduced, making it easier for both patients and medical staff managing an austere environment.