Therapeutic Taping to Offload Wound Margin Strain and as an Adjunct to Wound Closure: A Case Report

The chronic wound resulting from long-term nonhealing is a common complication after spinal surgery. In the case described herein, nonhealing may primarily have been the result of a too-small suture distance or high muscle tension of the lower back.

Skin stretching technique is a commonly used clinical method to assist wound healing, mainly because it can markedly reduce wound closing tension. The authors of the current case report successfully used Kinesio Tape (Kinesio), an elastic therapeutic tape, for skin stretching to achieve healing of a chronic wound in 1 patient.

An 86-year-old male with a history of diabetes was diagnosed with spinal suppurative osteomyelitis and underwent spinal debridement and debridement of dead bone. An incision of approximately 9 cm in length was used. Postoperative treatment included analgesia (parecoxib sodium 10 mg once daily for 3 days postoperatively) and prophylactic antibiotics (cefuroxime sodium 1.5 g twice daily for 2 days postoperatively). The wound was disinfected with 75% alcohol and covered with sterile gauze. All postoperative wound care was performed by the same physician.

On postoperative day 5, local blister formation on the wound surface was found; 75% alcohol was used for disinfection and the dressing was changed daily, but the wound surface did not obviously improve. Gradually, the blister burst and a skin liquefaction defect around the wound was formed. On postoperative day 40, further deterioration of the skin defect ceased. At that time, the wound measured approximately 5 cm × 2 cm and the wound was dry, with no exudate or swelling (Figure 1).

On postoperative day 45, the sutures were removed. Routine disinfection and dressing were maintained for an additional 37 days, but the only change to the wound consisted of skin crusting at the wound periphery, with no obvious healing in the wound bed. On postoperative day 82, elastic therapeutic tape was applied to stretch the skin around the wound to promote healing. After stretching with the elastic therapeutic tape, the wound was relatively closed (Figure 2).

Routine disinfection and daily dressing change was continued, and on postoperative day 110 the wound was completely covered with crusting. On postoperative day 125, the 2 ends of the crusting were trimmed in an aseptic environment to observe wound healing; the wound had healed well. The elastic therapeutic tape was removed 3 days later, and the patient was discharged. The patient was instructed to change the dressing 2 to 3 days after discharge. Complete wound healing was observed on postoperative day 143 (Figure 3). There was no change in the wound at the 6-month follow-up after wound healing was confirmed.

In the course of postoperative treatment, no bacterial growth was found in samples taken from the wound, and no increase in white blood cell count was found in routine blood tests. The ESR and CRP levels slightly increased within 110 days postoperatively. There was no obvious abnormality in routine blood tests, ESR, or CRP level 1 day before discharge.

The principle of stretching skin to promote wound closure is that when the skin is in a state of tension, it shows the characteristics of mechanical creep and stress relaxation.¹ Mechanical creep refers to the phenomenon that the skin is elongated owing to the straightening and rearrangement of dermal collagen fibers when continuous wound closure techniques are used. Stress relaxation occurs when the skin is stretched for a set distance and the tension required to keep the skin stretched to that distance decreases over time; that is, when the skin stretching device is released, the skin often loses retraction. The skin is viscoelastic and inherently malleable; thus, stretching in a certain range not only does not damage the activity of the skin, but it can bring the edges of the wound closer to each other and promote wound closure.

Invasive and noninvasive skin stretching devices are available; noninvasive skin stretching reportedly carries a lower risk of wound edge necrosis.² Wang et al³ treated 42 patients with postoperative diabetic foot wounds using a noninvasive skin stretching device combined with a negative pressure device. Compared with the 42 patients in the control group who received negative pressure wound therapy and conventional dressings, the time to wound healing was significantly shorter (P =.000) and the healing rate significantly improved (P =.002) in the treatment group. Using a skin stretching device similar to that used by Wang et al,³ Xue et al⁴ achieved successful healing in 2 patients with large skin defects. Cheng et al⁵ used elastic rubber bands to stretch the skin around 22 large wounds. Healing was achieved in 21 patients (mean healing rate, 95.45%). The devices used in these studies did not damage the skin around the wound, can reduce the risk of wound edge necrosis, and can be applied in the clinic. Shortcomings of such devices include high cost and complex application.

The elastic therapeutic tape used in the current case report is an excellent viscoelastic material that is widely used for clinical pain control and rehabilitation.⁶ Advantages of this material include ease of acquisition and low cost. Before being applied to the skin, the elastic therapeutic tape can be stretched to 140% of its original length, which suggests that the elastic therapeutic tape can provide an adequate contraction force for helping wounds heal when it is applied to the skin after stretching.⁷ This tape can improve blood flow and lymphatic circulation. One study has shown that the supportive effect of the elastic therapeutic tape used in the present case report can promote and enhance muscle function by making muscles work more effectively.⁸ Based on the findings of these studies, it seems as though elastic therapeutic tape could be used on spinal incision sites postoperatively to stretch the skin to approximate the wound edges, reduce muscle tension in the lower back, and improve local blood circulation at the wound site to aid in healing.

The use of elastic therapeutic tape to aid in chronic wound closure does not affect the need for wound disinfection and dressing changes. All invasive injuries increase the risk of wound infection. The scope of the application of elastic therapeutic tape is not clear. In the case discussed in the current report, use of the tape to promote wound healing was facilitated by the small size of the wound and the presence of sufficient healthy skin on the lower back to which adhesive tape could be affixed. It is not known whether elastic therapeutic tape can provide sufficient tension to manage larger wounds. Additional studies with larger numbers of patients and including wounds of different sizes and locations are needed to further study the use of elastic therapeutic taping.

Elastic therapeutic taping can offload the strain on the margins of chronic nonhealing wounds and promote healing, especially in those wounds attached to abundant muscle (eg, wounds about the waist). This case report may provide general guidance on the clinical treatment of chronic wounds and particular guidance to surgeons who manage such wounds. Future reports of clinical experience are planned to provide higher quality clinical evidence for the use of elastic therapeutic tape in promoting wound healing after spinal surgery.