Adjustable, Skin-Stretching External Fixation Device and Negative Pressure Wound Therapy Application for Infected Full-Thickness Skin Defects

A Case Series Study

Ye Peng, MD; Wei Zhang, MD; Faran Bokhari, MD; Zuo Cao, MD; Gongzi Zhang, MD; Shuwei Zhang, MD; Lihai Zhang, MD


Wounds. 2021;33(7):178-184. 

In This Article

Materials and Methods

Demographic Characteristics

From January 2014 through December 2017, 7 patients (3 males, 4 females) with full-thickness skin defects were treated with an adjustable, skin-stretching external fixation device and NPWT. The average patient age was 37.43 years ± 10.47 SD (range, 26–55 years). The average skin defect area was 226.29 cm2 ± 236.18 (range, 9–532 cm2). These skin defects were caused by burns, infection, trauma, surgery, and necrosis (Table).

Technique Description

Debridement. All dead, damaged or infected tissue was removed. An abrasion technique was applied in which scalpels and curettes were used to scrape the wound tissue until fresh bleeding occurred. The biofilm and devitalized tissue were removed. The wound was washed out to remove any free tissue. Saline and povidone-iodine were repeatedly used for wound irrigation.

Skin Stretching. Using a running suture technique, 2 parallel 2.5-mm– or 3.0-mm–diameter Kirschner wires (K-wires) were placed through the skin every 5 cm in a full-thickness fashion 3 cm from the distal and proximal aspects of the wound (Figure 1). Both sides of the skin edges were connected with an adjustable external fixator. Skin stretching was performed by shortening the external fixator and maintaining the skin tension. The skin was stretched at a rate of 1 mm per day.

Figure 1.

Steps for skin stretching. Step 1: install the Kirschner wires along the wound sides. Step 2: install the traction bar at both sides of the Kirschner wires. Step 3: start skin stretching (straight arrows) by rotating the top and bottom nuts (curved arrows).

Negative Pressure Wound Therapy. The NPWT device was first placed under the skin after debridement to promote the growth of granulation tissue and left in place for 1 to 3 weeks (depending on the control of the infection). After this, the NPWT device was moved to the superficial skin and left in place until wound closure was achieved. The negative pressure was set at 16.8 kPa (125 mm Hg), and the dressing was changed every 3 days to 5 days. If the infection was not under control, antibiotic cement beads could have been placed in the wound after 1 week of debridement.

Standard Care of Wound. The wound was checked daily, making sure the tension of the stretched skin was maintained but not too strong. When ulcerations were found at the skin edge or the patient experienced too much pain, the skin stretching was slowed. When both sides of the wound made contact, suture surgery was performed, followed by standard dressing care.

While undergoing skin stretching, patients were managed as inpatients; after wound closure, they were managed as outpatients.