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American Association of Plastic Surgeons

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200 Wound Defects Closed By Regenerative Surgery
Kimberly Khouri, MD1, Daniel Calva, MD2, Raul Cortes, MD2, Roger K. Khouri, MD2.
1Combined Harvard Plastic Surgery Program, Boston, MA, USA, 2Miami Hand Center, Key Biscayne, FL, USA.

PURPOSE:
One-millimeter puncture wound gaps regenerate with essentially no scar. Stacking a multitude of these gaps in a mesh expansion pattern can add up to a substantial amount of scarless tissue regeneration. We report our experience with this regenerative wound closure alternative to treat defects that would have otherwise required flaps. METHODS:After tumescent anesthesia we place the wound edges under extreme tension. Then, with a 1.2 mm needle that preferentially severs tensed tissues, we inflict a staggered alternating pattern of full-thickness needle punctures down to the restrictive fascia. Each puncture nicks the tight tissues to release a tiny amount of tension. We start peripherally and, as the tension is relieved through mesh expansion, we move towards the edges till a tensionless closure is achieved. We avoid undermining and meshing close to the edges. RESULTS:
We closed with this technique 200skin cancer excision wound defects (3cm2-60cm2) that would have required flaps. The wounds healed uneventfully with a straight-line scar as long as we meshed 10cm for every 2cm of required tissue gain. Complications were seen when the expansion ratio exceeded 20%. Interestingly, blind needle punctures caused no nerve damage. CONCLUSION: Percutaneous mesh expansion is a simple regenerative wound closure alternative to “Borrowing from Peter to pay Paul”. The sum of tiny gaps regenerates enough tissue to advance the wound edges beyond their viscoelastic property.


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