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The continuous external tissue expansion device DermaClose may achieve closure of complex wounds in pediatric patients with traumatic injury, according to a recent report by May et al. 1 Although several articles have described the use of DermaClose for the treatment of lower extremity wounds in the adult population, both traumatic and nontraumatic, and it has been reported in adult scalp wounds preoperatively and postoperatively for planned procedures with low morbidity and high satisfaction rates, this is the first report of the use of DermaClose in pediatric patients with a traumatic injury.
The authors present 3 successful pediatric cases of soft tissue reconstruction using DermaClose as an alternative to free tissue transfer: 2 with open tibial fractures and 1 with an avulsion injury to the scalp. Initial complex wound closure with conservative management failed in 2 of the reported cases, suggesting that DermaClose should be considered for initial use in complex or difficult wounds to avoid wound closure failure.
In this report, repeated reinstallations of the DermaClose device were necessary to achieve closure in larger wounds, though there was no direct correlation between wound size and number of reinstallations. Other factors such as wound shape, wound-edge jaggedness, skin laxity, wound location, and cleanliness of the wound at device application and throughout the healing process may also affect the number of reinstallations and days to device removal. When complete closure was not achieved with DermaClose alone, split-thickness skin grafting and local wound care were used; however, more invasive methods such as full-thickness tissue transfer or thigh flaps for wound coverage were avoided.
A systematic review of the literature revealed that to date most studies of continuous external tissue expansion using DermaClose have focused on adult patients and planned procedures rather than the treatment of pediatric patients or traumatic injuries. The scant available literature on the use of DermaClose in pediatric patients reports successful outcomes, and none advise against its use in adult or pediatric populations.
This report of pediatric patients with traumatic injury who were treated with DermaClose demonstrates its safety and efficacy in this population, with no adverse events observed and improved aesthetic outcomes in the same or less time than with conservative wound management.
1. May BL, Googe B, Durr S, et al. Utility of a continuous external tissue expander in complex pediatric wound reconstruction. ePlasty. 2022;22:e10
Video Transcript
Author Insights: Continuous External Tissue Expansion in Pediatric Trauma Patients
Dr Ian Hoppe: Hello. My name is Ian Hoppe. I'm a pediatric plastic surgeon at Children's of Mississippi in Jackson, Mississippi. I also serve as the surgeon in chief for the children's hospital at this institution.
Prompt 1: What challenges of wound closure are unique to pediatric trauma patients?
Dr Ian Hoppe: When facing pediatric wounds, we oftentimes utilize the same reconstructive ladder that we use for adult patients that we are all familiar with in the plastic surgery world. However, sometimes this reconstructive ladder needs to be altered based on the fact that the child is a pediatric patient. And in order to accomplish wound closure most effectively, you may have to use adjunctive measures to accomplish this.
Prompt 2: How does a continuous external tissue expander address these challenges?
Dr Ian Hoppe: A continuous external tissue expander can oftentimes assist with wound closure in the pediatric population. And at times may preclude a free tissue transfer, which depending on the age of the child could present very unique challenges due to their smaller anatomic features.
Prompt 3: What areas of the body can be treated using CTE?
Dr Ian Hoppe: All areas of the body can be treated with continuous external tissue expansion. We have had success in the scalp and the lower extremity. And again, in those instances have oftentimes avoided either a free tissue transfer or a large local regional flap reconstruction.
Prompt 4: What is the future of CETE?
Dr Ian Hoppe: I believe in the future, continuous external tissue expansion could be utilized to, again, accomplish wound closure in areas where perhaps a larger reconstructive surgery would be needed, or may not even be possible given the patient's age.
Prompt 5: What is a key takeaway message that you would like your colleagues to know?
Dr Ian Hoppe: I think it's important for plastic surgeons that take care of pediatric patients to be aware of continuous external tissue expansion and consider its use in challenging wounds where other options may not be as attractive.
