CLOSURE OF MAJOR SOFT TISSUE DEFECTS BY MODIFIED KW STRETCHING DEVICES AND VAC

Our experience using a skin stretching device applying KW and rib retractors for the approximation of extensive skin loss in the treatment of complex injuries involving massive loss of soft tissue is presented. Major soft tissue injury inflicted by the detonation of explosives in close proximity requires a unique approach for the closing of massive gaping wounds. This method has been applied in multiple situations at our medical center since 1995. The technique involved insertion of the KW into the deep dermal layer along the longitudinal edges on both sides of the wound, and the application of rib retractors to approximate the skin edges. Lately we have been combining this method with vacuum-assisted skin closure (VAC). This method enabled closure of massive soft tissue losses of limbs, trunks, and abdominal wall. Approximation of wound edges necessitated in some cases minor skin grafting of the residual gap. Application of the VAC system reduced edema, infection rate and skin necrosis, and also enabled early skin grafting. We will describe the novel use of VAC in extensive soft tissue trauma. The KW stretching device is inexpensive and is readily available in any OR setup. It enables setting of a vector traction on wound edges in a more homogenous manner. The VAC system may be combined for optimizing treatment.