Sutura elástica para tratamento de grandes feridas

The suture of extensive wounds remains a major challen ­ ­ge­ for­ plastic­ surgeons.­ Skin­ and­musculocutaneous­ flaps­ (direct, with vectors, or after utilization of skin expanders) are the surgical alternatives more commonly used to close extensive wounds. However, these procedures often provide unsatisfactory results even when performed by experien ­ ced plastic surgeons1. Other alternatives rely on the use of bandages to cover the wound until granulation occurs; this Elastic sutures for the treatment of extensive wounds


INTRODUCTION
The suture of extensive wounds remains a major challen ge for plastic surgeons.Skin and musculocutaneous flaps (direct, with vectors, or after utilization of skin expanders) are the surgical alternatives more commonly used to close extensive wounds.However, these procedures often provide unsatisfactory results even when performed by experien ced plastic surgeons 1 .Other alternatives rely on the use of bandages to cover the wound until granulation occurs; this Elastic sutures for the treatment of extensive wounds Sutura elástica para tratamento de

ABSTRACT
The suture of extensive wounds remains a major challenge for plastic surgeons.The objec tive of this article is to promote use of elastic sutures as an effective procedure for the closure of extensive wounds.Fourteen patients presenting with extensive wounds caused by trauma in the lower limbs were included in the study.The entire wound was sutured in eachpatientwithatwo-stepprocedure.Inthefirststep,theoppositeedgesofthewound were approximated using rubber circular elastic bands.In the second step, carried out a fewdayslater,theelasticbandswereremoved,followedbyasimplesuturewithmonofila ment nylon thread.Placement of elastic sutures proved to be a safe, functionally effective, easyt operform, and lowcost procedure for the closure of extensive wounds without using donor areas as skin grafts.
is followed by partial or total skin graft.Another option is to treat the wound until spontaneous approximation of the edges occursorthewoundisnaturallycoveredwithfibroustissue.
In 1993, Raskin 2 described a suture technique with sterile elastics that avoids creating tension when wounds are closed and prevents the necessity of skin grafts for wounds that are left open.
The objective of this article is to promote placement of elasticsuturesasanefficient,low-cost,andfastprocedure for the closure of extensive wounds.

METHODS
Fourteen patients presenting with extensive lesions cau sed by trauma in the lower limbs were included in the study.The patients attended the plastic surgery service of João XXIII and Maria Amélia Lins Hospitals (Belo Hori zonte, MG, Brazil) between February and July 2011.
Only injuries that did not allow primary sutures were selected for this study.All procedures were performed for adult individuals (age, 18-52 years; 13 men and 1 woman) who had no comorbidities.
The procedure was carried out in 2 surgical steps.In the first step, a small flap dissection (approximately 2 cm) was performed, and the opposite edges of the wound were approximated using rubber elastic circular bands.The tech nique consisted of initial suturing with 20 nylon thread, which included the elastic and one of the vertexes of the wound.The rubber was then folded across itself to form an X shape.Next, stitches were used to fix each side at both edges of the wound, including the other vertex.Attention was paid to avoid too much pull on the elastic in order to avoid excessive skin tension, even when exposed areas we re left open.
Between 7 and 15 days later, once the surgical edges were sufficientlyclosed,asecondsurgerywasperformed,inwhich the elastic bands were removed and simple suturing with monofilamentnylonthreadwascarriedout.Thewoundswere cleaned daily with saline solution, and an occlusive dres sing with gauze soaked in mineral oil was applied.
Figures 1 to 3 illustrate some of the cases in this series.

RESULTS
In all of the 14 patients, secondary suturing of the skin was performed, with no skin grafts being necessary.Complete wound closure occurred between 7 and 15 days.Upon appro ximation of the edges of the wound, the skin was sutured with continuous or isolated stitches using 30 nylon thread.
No complications were observed in the wounds studied.Patients were discharged the day after the second surgery.Skin sutures were removed between 12 and 15 days after hos pital discharge.

DISCUSSION
Although elastic sutures can be used to close extensive wounds, few descriptions of this procedure are found in the national literature.In the past, this procedure was used for the treatment of compartment syndrome of the upper limb, for approximating aponeuroses with rubber elastic bands 1 .
In a series of 21 patients, Petroianu 3 observed complete wound closure in 100% of cases, without the requirement of  any other procedures or auxiliary methods.A similar result was obtained in another study, which reported that in all pa tients where secondary suturing of the skin was carried out, there was no requirement for grafting 4 .With this suturing method, treatment costs are reduced.Moreover, this method ensures satisfactory and high quality aesthetic results when compared to those of skin grafting, a commonly used alternative for closing extensive wounds.

CONCLUSIONS
Placement of elastic sutures proved to be a safe, functio nally effective, easytoperform, and lowcost procedure for the closure of extensive wounds, thus avoiding the use of donor areas as skin grafts.

Figure 1 -Figure 2 -Figure 3 -
Figure 1 -In A, fasciotomy of the lower limb.In B, placement of elastic sutures.In C, completion of suturing, with immediate reduction of the wound.In D, almost complete wound closure, a few days after the placement of elastic sutures.
grandes feridas Elastic sutures for the treatment of extensive wounds