Tie-over dressing is frequently used in plastic surgery to ensure the adherence of a skin graft to the wound bed. The traditional technique is based on the application of long silk sutures along the circumference of the graft that are tied over impregnated nonadherent tulle gras filled with a bolus of fluffy gauze.
Tie-over dressing is frequently used in plastic surgery to ensure the adherence of a skin graft to the wound bed. The traditional technique is based on the application of long silk sutures along the circumference of the graft that are tied over impregnated nonadherent tulle gras filled with a bolus of fluffy gauze.
Tie-over dressing is frequently used in plastic surgery to ensure the adherence of a skin graft to the wound bed. The traditional technique is based on the application of long silk sutures along the circumference of the graft that are tied over impregnated nonadherent tulle gras filled with a bolus of fluffy gauze.
A New Useful and Renewable Tie-Over Dressing Method
Using Package Bands and Bra Hooks Fatih Dogan, MD, I
rfan O
zyazgan, MD, and Teoman Eskitascoglu, MD
Abstract: The purposes of the tie-over dressing are to secure a skin graft toward the wound bed to avoid complications such as uid or blood accumulation and to prevent graft movements over the wound bed. When there is a concern of uneventful graft take because of infection or blood accumulation underneath the graft, it is necessary to check the status of the graft at the postoperative rst and subsequent days. Therefore, an ideal tie-over dressing method should not only ensure adequate immobilization and pressure but also be able to be renewed simply and quickly. We developed a new tie-over dressing method by using bra hooks and packing rubber bands to solve these problematic issues. Key Words: bra hook, package band, tie-over dressing (Ann Plast Surg 2006;57: 348349) T ie-over dressing is frequently used in plastic surgery to ensure the adherence of a skin graft to the wound bed. The traditional technique is based on the application of long silk sutures along the circumference of the graft that are tied over impregnated nonadherent tulle gras lled with a bolus of uffy gauze. The dressing is usually left in place for approx- imately 5 days. The purposes of the tie-over dressing are to secure a skin graft toward the wound bed to avoid compli- cations such as uid or blood accumulation and to prevent graft movements over the wound bed. When there is a concern of uneventful graft take be- cause of infection or blood accumulation underneath the graft due to clinical (ie, a graft over a muscle) or pharmacological (ie, use of anticoagulants or antiaggregants) reasons, it is necessary to check the status of the graft at the postoperative rst and subsequent days. In this way, it is possible to see and solve the problems so that complications can be prevented before complete graft lost occurs. Therefore, an ideal tie-over dressing method should not only ensure adequate immobili- zation and pressure but also be able to be renewed simply and quickly. We developed a new tie-over dressing method by using bra hooks and packing rubber bands to solve these problematic issues. In this new method, skin stapler or regular sutures are used to staple the graft circumferentially after adjustment of the graft to the skin defect, and then, the underneath area of the graft is irrigated with saline, as in the normal procedure. Received February 13, 2006, and accepted for publication February 24, 2006. From the Department of Plastic and Reconstructive Surgery, Erciyes Uni- versity, Faculty of Medicine, Kayseri, Turkey. Reprints: Fatih Dogan, MD, Erciyes University, Faculty of Medicine, Depart- ment of Plastic and Reconstructive Surgery, 38039, Melikgazi, Kayseri, Turkey. E-mail: fdogan@erciyes.edu.tr. Copyright 2006 by Lippincott Williams & Wilkins ISSN: 0148-7043/06/5703-0348 DOI: 10.1097/01.sap.0000218634.91706.f3 FIGURE 1. Grafted area on the deltoid region. Bra hooks are placed peripherally on intact skin. FIGURE 2. Completed tie-over dressing using defined method. Annals of Plastic Surgery Volume 57, Number 3, September 2006 348 Following this, the presterilized bra hooks are reciprocally xed onto the intact skin surrounding the grafted wound using silk sutures (Fig. 1). The bolus dressing is placed over the nonadhering tulle gras covering the graft. The rubber bands are hitched to the bra hooks reciprocally crossing over the bulky dressing. Crossing the bands to another bra hook tightens the bands as much as possible when greater pressure is required (Fig. 2). Different-sized bands and bra hooks may be used for different-sized grafted wounds. This new method has been performed in our clinic to ensure contact between the graft and the bed, with no discomfort to the patient, and the dressing has been re- placed until the graft take is completed in previously mentioned risky situations. We believe that the elasticity of the bands offers an additional important advantage of continual pressure application over the dressing. This pres- sure might easily be lost when silk sutures are used once to squeeze the bolus. The predominant advantage of this new method is the fact that the materials used are easily available and even less expensive than silk sutures, which are used in conventional tie-over dressing techniques. The ability to complete this tie-over dressing by 1 physician offers another obvious ad- vantage of this new method: assistance is needed while knotting the sutures over bolus in ordinary dressings. In conclusion, we describe a new method which is effective, easy to apply, inexpensive, and useful for skin graft applications when tie-over dressing is found necessary. Annals of Plastic Surgery Volume 57, Number 3, September 2006 Tie-Over Dressing Using Package Bands and Bra Hooks 2006 Lippincott Williams & Wilkins 349