Establishing tension-free direct wound closure is important for optimal postsurgical wound healing. Direct closure should not be forced by raising wound tension.
Objective:
The aim of this article is to review the viscoelastic properties of skin and describe tension-relieving techniques to aid optimal wound closure.
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References
1.
Al-BennaSAl-AjamYTzakasESuperficial fascial system repair: an abdominoplasty technique to reduce local complications after caesarean delivery. Arch Gynecol Obstet2009;279:673–5, doi:10.1007/s00404-008-0802-5..
2.
Al-BennaSTzakasEPostablative reconstruction of vulvar defects with local fasciocutaneous flaps and superficial fascial system repair. Arch Gynecol Obstet2012;286:443–8, doi:10.1007/s00404-012-2262-1..
3.
Al-BennaSBilateral alar cartilage reduction rhinoplasty allows primary repair of alar defects in the bulbous nose. J Cutan Med Surg2012;16:424–7.
4.
Al-BennaSKirkpatrickJJTaggartIMinimally invasive harvesting of adipofascial scapular flaps. Ann Plast Surg2012Dec13. [Epub ahead of print]
5.
SteinstraesserLFlakEWitteB. Pressure garment therapy alone and in combination with silicone for the prevention of hypertrophic scarring: randomized controlled trial with intraindividual comparison. Plast Reconstr Surg2011;128:306e–13e, doi: 10.1097/PRS.0b013e3182268c69..
6.
SteinstraesserLRittigAGeversK. A human full-skin culture system for interventional studies. Eplasty2009;9:e5.
7.
Al-BennaSO'BoyleCHolleyJExtravasation injuries in adults. ISRN Dermatol2013;2013:856541.
8.
AndreeCLangerSSeidenstueckerK. A single center prospective study of bilateral breast reconstruction with free abdominal flaps: a critical analysis of 144 patients. Med Sci Monit2013;19:467–74, doi:10.12659/MSM.883954..
9.
Al-BennaSSteinstraesserLPataniNFree flap breast reconstruction consent forms should warn against the potential loss of the internal thoracic artery for coronary artery bypass grafting. Plast Reconstr Surg2012;129:867e–8e, doi:10.1097/PRS.0b013e31824a9e95..
10.
LoeffelbeinDJAl-BennaSSteinsträßerL. Reduction of donor site morbidity of free radial forearm flaps: what level of evidence is available?Eplasty2012;12:e9.
11.
SteinstraesserLAgarwalRStrickerI. Biphasic synovial sarcoma of the extremity: quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation to avoid amputation. Case Rep Oncol2011;4:222–8, doi:10.1159/000327845..
12.
Al-BennaSSteinsträsserLPostablative reconstruction is better terminology than oncoplastic surgery. Plast Reconstr Surg2009;124:463e–4e, doi:10.1097/PRS.0b013e3181bf7fe3..
13.
Al-BennaSSteinauHUSteinstraesserLSuperficial vein thrombosis 21 cm distant from the venous anastomosis of a free flap causing intermittent venous congestion. Eplasty2009;9:e32.
14.
Al-BennaSSteinstraesserLSteinauHUThe cross-lip flap from 1756 to 1898. Reply to “The Sabattini-Abbé flap: a historical note. Plast Reconstr Surg2009;124:666–7, doi:10.1097/PRS.0b013e3181adddef..
15.
KestingMRLoeffelbeinDJClassenM. Repair of oronasal fistulas with human amniotic membrane in minipigs. Br J Oral Maxillofac Surg2010;48:131–5, doi:10.1016/j.bjoms.2009.04.025..
16.
Al-BennaSFemale plastic and reconstructive surgeons' personal decision making for breast cancer treatment and reconstruction. Arch Gynecol Obstet2011;284:737–41, doi:10.1007/s00404-010-1721-9..
17.
Al-BennaSGrobMMosahebiA. Caution note on the use of the internal mammary artery in breast reconstruction. Plast Reconstr Surg2006;117:1653–54, doi:10.1097/01.prs.0000208865.31910.48..
18.
Al-BennaSCaution in the use of the internal mammary artery in breast reconstruction. Plast Reconstr Surg2007;120:348, doi:10.1097/01.prs.0000264563.48652.a6..
19.
Al-BennaSAl-BusaidiSSPapadimitriouG. Abdominoplasty consent forms do not caution against the potential loss of a reconstructive option for breast reconstruction. Plast Reconstr Surg2009;123:208e–9e, doi:10.1097/PRS.0b013e3181a8490a..
20.
Al-BennaSGrobMPrimary hypotension: a contraindication to free tissue transfer?Plast Reconstr Surg2006;117:2509, doi:10.1097/01.prs.0000219988.34178.07..
21.
Al-BennaSConstruction and use of wound care guidelines: an overview. Ostomy Wound Manage2012;58:37–47.
22.
Al-BennaSA discourse on the contributions of evidence-based medicine to wound care. Ostomy Wound Manage2010;56:48–54.
23.
Al-BennaSPerioperative management of morbid obesity. J Perioper Pract2011;21:225–33.
24.
BrownIAA scanning electron microscope study of the effects of uniaxial tension on human skin. Br J Dermatol1973;89:383–93, doi:10.1111/j.1365-2133.1973.tb02993.x..
25.
WilhelmiBJBlackwellSJMancollJS. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg1998;41:215–9, doi:10.1097/00000637-199808000-00019..
26.
Al-BennaSTzakasEIntrauterine rectovaginal tear during a manual attempt to rotate a neonate. J Pediatr Surg2010;45:e11–3, doi:10.1016/j.jpedsurg.2010.05.035..
27.
DupuytrenJFTraité, théorique et pratique des blessures par armes de guerre, rédigé d'après les leçons cliniques de Dupuytren. 1st ed.Paris: JB Bailliere; 1834.
28.
LangerKZur Anatomie und Physiologie der Haut: I. Über die Spaltbarkeit der Cutis. Die Spannung der Cutis. Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften mathematischnaturwissenschaftlichen Classe. Abteilung 1 Mineralogie, Botanik, Zoologie, Anatomie, Geologie, Paläontologie 44. 1st ed.Vienna: Gerold; 1861. p. 19–46.
29.
LangerKZur Anatomie und Physiologie der Haut: II. Über die Spaltbarkeit der Cutis. Die Spannung der Cutis. Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften mathematischnaturwissenschaftlichen Classe. Abteilung 1 Mineralogie, Botanik, Zoologie, Anatomie, Geologie, Paläontologie 44. 1st ed. Vienna: Gerold; 1862. p. 133–88.
30.
CoxHThe cleavage lines of the skin. Br J Surg1941;29:234–40, doi:10.1002/bjs.18002911408..
31.
KraisslCThe selection of appropriate lines for elective surgical incisions. Plast Reconstr Surg1951;8:1–28, doi:10.1097/00006534-195107000-00001..
32.
BorgesARelaxed skin tension lines (RSTL) versus other skin lines. Plast Reconstr Surg1984;73:144–50, doi:10.1097/00006534-198401000-00036..
33.
ThackerJGRodeheaverGMooreJW. Mechanical performance of surgical sutures. Am J Surg1975;130:374–80, doi:10.1016/0002-9610(75)90408-0..
34.
LarrabeeWFJr. A finite element model of skin deformation. I. Biomechanics of skin and soft tissue: a review. Laryngoscope1986;96:399–405.
35.
CoxKWLarrabeeWJr. A study of skin flap advancement as a function of undermining. Arch Otolaryngol1982;108:151–5, doi:10.1001/archotol.1982.00790510023005..
36.
Al-BennaSEconomical negative pressure wound therapy. Ann R Coll Surg Engl2012;94:214, doi:10.1308/003588412X13171221589694g..
37.
LiangMDBriggsPHecklerFRFutrellJWPresuturing—a new technique for closing large skin defects: clinical and experimental studies. Plast Reconstr Surg1988;81:694–702, doi:10.1097/00006534-198805000-00008..
38.
JohnsonTMBrownMDSullivanMJSwansonNAImmediate intraoperative tissue expansion. J Am Acad Dermatol1990;22:283–7, doi:10.1016/0190-9622(90)70038-J..
39.
BelkoffSMNaylorECWalshawR. Effects of subcutaneous expansion on the mechanical properties of porcine skin. J Surg Res1995;58:117–23, doi:10.1006/jsre.1995.1019..
40.
CodvillaAOn the means of lengthening in the lower limbs, the muscles, and the tissues which are shortened through deformity. Am J Orthop Surg1905;2:353–69.
41.
KörberAKlodeJAl-BennaS. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges2011;9:116–21.
