• Archives of Plastic Surgery
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• 제38권4호
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• pp.552-554
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• 2011

Purpose: Though its general usage, traditional tie-over dressing using suture has a few drawbacks such as difficulty in re-fixation after its opening especially when hematoma or seroma has occurred. It is rather difficult to maintain a stable dressing on curvy parts of body like flank, buttocks and that leads to unsatisfactory results of the surgery. Authors recommend a quick and repeatedly doable method, tie-over dressing that incorporates the usage of hooks and rubber bands. Methods: Debridement was done at a recipient site to be able to do skin graft. A right size of skin graft was prepared and placed upon the defect site with suture. Enough number of hooks were attached using Blue nylon at the normal skin of the edge of grafted area. We Applied dressing with ointment and fluffy gauze then fixed the dressing by attaching a rubber band at the hook to give a certain amount of tension. One or two days after the surgery, we opened the tie-over dressing and repeated the tie-over dressing by reusing the hooks and rubber band. Results: The skin grafts were all successfully taken and by repeating tie-over dressing using hooks and rubber, we could take the advantage of shortened the dressing time and eliminate the inconvenience of the patient and the surgeon by using bandages and fixing tapes. Conclusion: The advantage of tie over dressing using hooks and rubber bsnds are its easy re-doability early detection of probable complications, preventability of reoccurence of hematoma and seroma. Therefore, authors report this as considering the tie-over dressing using hooks and rubber bands is recommendable.

• Archives of Plastic Surgery
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• 제45권3호
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• pp.266-270
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• 2018

Background Skin grafting is a commonly performed operation in plastic and reconstructive surgery. The tie-over dressing is an effective technique to secure the grafted skin by delivering persistent downward pressure. However, if an additional dressing is required due to incomplete graft healing, the process of re-implementing the tie-over dressing may be frustrating for both patients and surgeons. Therefore, we introduce the double tie-over dressing, which readily allows for an additional tie-over dressing after the first dressing, and we present a comparison of its effectiveness with that of the simpler bolster dressing. Methods Of 128 patients with a skin defect, 69 received a double tie-over dressing and 59 patients received a simple bolster dressing. Using the independent t-test, the mean healing time, which was defined as the mean time it took for the wound to heal completely so that no additional dressing was required and it was washable with tap water, was compared between the 2 groups in both the head and neck region and in other areas. Results The mean healing time for the head and neck region in the double tie-over dressing group was $9.19{\pm}1.78days$, while it was $11.05{\pm}3.85days$ in the bolster dressing group. The comparison of the 2 groups by the independent t-test revealed a P-value of 0.003 for the mean healing time. Conclusions In the head and neck area, the double tie-over dressing required less time to heal than the simple bolster dressing.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.259-262
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• 2013

After skin grafting, to prevent hematoma or seroma collection at the graft site, a tie-over dressing has been commonly used. However, although the conventional tie-over dressing by suture is a useful method for securing a graft site, refixation is difficult when repeated tie-over dressing is needed. Therefore, we recommend a redoable tie-over dressing technique with multiple loops threads and connecting silk threads. After the raw surface of each of our cases was covered with a skin graft, multiple loop silk thread attached with nylon at the skin graft margin. We applied the ointment gauze and wet cotton/fluffy gauze over the skin graft, then fixed the dressing by connecting cross-counter multiple loop thread with connecting silk threads. When we opened the tie-over dressing by cutting the connecting silk threads, we repeated the tie-over dressing with the same method. The skin graft was taken successfully without hematoma or seroma collection or any other complications. In conclusion, we report a novel tie-over dressing enabling simple fixation of the dressing to maintain proper tension for wounds that require repetitive fixation. Further, with this reliable method, the skin grafts were well taken.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.26-31
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• 2011

Purpose: We compared wound healing between the conventional tie-over dressing and silicone sheeting after skin grafting in patients with skin defects. Materials and Methods: Of a total of 30 cases of skin defects, 15 underwent conventional tie-over dressing and the remaining 15 underwent silicone sheeting skin grafting, we compared hematoma formation and infection status between the 2 techniques 1 and 2 weeks after operation Results: Hematoma was not observed in all cases. The wound infection rate decreased in silicone group. Conclusions: Silicone sheeting skin graft may be helpful in reducing wound infection.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.607-612
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• 2005

A traditional tie-over dressing may be applied to support the take of a skin graft. Although there are many advantage of this method, it has significant disadvantages, including time-consuming application. Furthermore, when the dressing is changed, the gauze becomes hard and can be stuck to the graft, causing damage and pain upon removal. The purpose of our study is to evaluate the effect of semi-occlusive dressing using polyurethane foam and film dressing($Allevyn^{(R)}$, $Opsite^{(R)}$) after full thickness skin graft. The authors treated 45 cases including burn scar contracture(n=38), syndactyly (n=1), absence of nipple-areolar complex(n=4), traumatic skin defect(n=1) and contact burn(n=1) with authors' method and 39 patients including burn scar contracture (n=39) with the tie-over dressing between 2000 and 2004. The patients in polyurethane foam and film dressing group ranged from 1 to 62 years of age (mean age, 15.1 years) and the patients in tie-over dressing group ranged from 2 to 60 years of age(mean age, 21.3 years). The postoperative results were analyzed according to the following measures: (1) the duration of graft-taking, (2) the admission period, (3) complications. Compared with the traditional tie-over dressing, polyurethane foam and film dressing was shown to be more successful in a reduced duration of graft-taking, in which was similar to the former in the rate of graft-taking, a reduced admission period and patient's discomfort. We concluded that semi-occlusive dressing using $Allevyn^{(R)}$ and $Opsite^{(R)}$ was an effective method after full thickness skin graft, which was easy to shape to difficult body locations, such as web spaces, fingers and maintains a moist environment for wound healing and does not stick to the wound.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.313-316
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• 2010

Purpose: Tie-over dressing is widely used to secure skin grafting on face, body, or extremities. It can be a rather complicated task and is not easy to make compressive dressing again if performed in a conventional method. So, we hereby introduce an easy reproducible tie over dressing method. Methods: After completing the skin graft, Cut the silastic drainage longitudinally in half and spread to the grafted skin margin. Drainage is fixed by using the stapes or sutures. A fluffy gauze bolus dressing is placed over a furacin impregnated gauze and wrapped around. After suturing the distal margin of silastics with opposite side using the silk thread either 5 - 0 or 3 - 0, knot of suturing, which is pressed down against the dressing while the threads are tightened, is made into center of each sides. Results: It can make dressing again after observing the grafted skin, and it can also make pressure on the grafted area evenly until the grafted skin is taken. Conclusion: This dressing method makes the surgeons and patients comfortable. To surgeons, it provides more rapid and easier way to do dressing, and to patients, it eliminates pain caused by redressing.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.727-734
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• 2009

Purpose: The Inaba's procedure, the treatment of osmidrosis axillae, has the advantages of low recurrent rate and easy to learn, yet it produces early postoperative discomfort and scar formation by tie - over dressing. The authors modified the Inaba's procedure by using delayed suture of the incision wound and omitting tie - over dressing. The comparative study of Inaba's procedure and its modification was performed to confirm the advantages of modified procedure. Methods: The study contains the retrospective analysis of the medical records of 296 patients with osmidrosis who were treated using the Inaba's procedure from December, 1996 to February, 2007. The study also contains the prospective analysis of 20 patients, from March, 2007 to July, 2008, who were treated by the modified Inaba's procedure with delayed suture of the incision wound and gentle pressure dressing instead of tie - over dressing. The operative results of two groups were compared and verified by Mann - Whitney U test(SPSS 12.0). Results: The incidence of complications was 14.5% in the Inaba's procedure, whereas 6.2% in the modified Inaba's procedure. Both procedures have the same basic surgical procedure in terms of the location of incision site and subdermal shaving of the sweat glands, and therefore similar good results were obtained in the aspect of postoperative axillary odor, recurrent rate and postoperative condition of axillary hair. Certainly, the modified Inaba's procedure had better outcome in each element of PSS(Patient Scar Self-Rating Scale), compared to the Inaba's procedure. In addition, the modified Inaba's procedure showed a statistical significance in dressing - related pain reduction and overall satisfaction. Conclusion: The modified Inaba's procedure had advantages of decreased early postoperative complications such as hematoma, discomfort and pain caused by tie - over dressing, and decreased scar formation. However, the drawback was delayed suture of the incision wound after 48 hours.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.711-714
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• 2013

Background The most common cause of skin graft failure is the collection of blood or serous fluid underneath the graft. In our study, we describe the use of silicone tube for tie-over dressing to secure the skin graft margins with the aim of decreasing loss of the skin graft, particularly in grafting of deep wounds. Methods Between March 2008 and July 2011, we used this technique in 17 patients with skin defects with depths ranging from 3.5 to 8 mm (mean, 5.5 mm). First, the skin graft was sutured with 3/0 silk suture material from its corners. Then, a silicone round drain tube was sutured with 3/0 absorbable polyglactin 910 over the margins of the graft. Finally, long silk threads were tied over the bolus dressing, and the tie-over dressing was completed in the usual fashion. Results The mean follow-up was 7 months (range, 2-10 months) in the outpatient clinic. Graft loss on the graft margins due to hematoma or seroma was not developed. The results of adhesion between the graft and wound bed peripherally was excellent. Conclusions In our study, we suggest that use of a silicone tube for additional pressure on the edges of skin grafts in case of reconstruction of deep skin defects.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.341-345
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• 2015

Background A tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required. Methods From January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively. Results The majority of cases were carried out for split-thickness skin grafts (n=19) used on the lower limb (n=20). The results of this novel technique were excellent with complete (100%) graft take in all patients. Conclusions Our results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.29-36
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• 2016

Purpose: Skin grafting is used for the transfer of cutaneous tissue from one site of the body to another. To improve graft survival, close contact between the graft and the wound bed is essential for vessels to grow across the gap. Here, we introduce an easy and efficient dressing method to improve graft survival. Materials and Methods: A retrospective chart review was performed to identify patients who underwent split thickness skin graft and negative pressure wound therapy (NPWT) or conventional treatment between January 2007 and April 2015. Overall, 25 consecutive patients were included in the NPWT group and 49 were included in the conventional dressing group to compare the outcome of the procedure. The data were obtained from medical records, including age, sex, cause of the skin defect, size of graft, time for healing, wound preparation time, and complications. Results: Of the NPWT group, the average wound size was $147.04{\pm}146.74cm^2$ (range, $9{\sim}900cm^2$). With the exception of one patient, all wounds healed without the need for further procedure. The average duration of time required for the NPWT group, which was defined as removal of stitches (or staples) and no need for additional active dressing, was $6.4{\pm}1.97days$ (range, 5~15 days). The average time for the conventional dressing group was $10.78{\pm}2.38days$ (range, 5~15 days). Conclusion: NPWT can be used to cover regions in which wound healing does not occur fully or when neither tie-over nor compressive dressings are applicable. This treatment also reduced wound healing time and allowed earlier patient mobilization and hospital discharge.