The use of external tissue expansion in the management of wounds and ulcers

A series of 43 wounds and ulcers in 37 patients were treated with the use of constant-tension approximation devices for periods ranging from 7 to 28 days. The etiologies of the lesions were diabetes; posttraumatic, including iatrogenic causes; neuropathic; pressure sores; and collagen disease. The approximation device is described and the technique of applying the device is detailed. The results are presented in tabulated form. The contraindications to the use of this methodology are discussed and the importance of patient selectivity is stressed. Evidence is presented to indicate that constant-tension approximation increases the healing rate as well as provides partial or complete full-thickness coverage, depending on the size of the wound. Such coverage reduces the recurrence rate and is usually only achieved by an operative approach, which is thus avoided. The socioeconomic advantages of this approach are mentioned.