PRS AAPS Oral Proofs 2016
Roger K. Khouri, MD,* Kimberly S. Khouri, BS,† Roger K. Khouri, Jr, BS‡
From the *Miami Dermatology and Plastic Surgery Center, Key Biscayne, Fla.; †New York University School of Medicine, New York City, N.Y.; and ‡University of Michigan School of Medicine, Ann Arbor, Mich.
PURPOSE: Puncture wounds less than 2 mm heal without scars. Stacking rows of 2-mm punctures offers a scarless method to generate tissue by mesh expansion. We describe percutaneous mesh expansion (PME) and present our experience with PME for wound closure.
METHODS: We applied PME to 43 consecutive patients aged 58 to 101 years (mean, 72 years) with 44 full-thickness calvarial defects 2.5 × 3 to 6 × 7 cm (mean, 3.5 × 4.0 cm) that would have all required flaps. Twenty-nine were still anticoagulated, and 18 had previous scalp resections. After tumescent epinephrine anesthesia, we temporarily approximate the wound by placing it under strong tension. By using 1.2-mm cutting point needles that selectively sever tissue under tension, we inflict rows of staggered alternating punctures over an area 5× the defect size. This results in 20% expansion of the meshed area, generating the tissue necessary for defect coverage. When the tension is completely released, closure is done with simple sutures or staples. We avoid overmeshing, especially close to the wound edges, and performed no undermining and no additional incisions.
RESULTS: Defects healed with only a straight resection scar. However, of the 6 defects of >5 × 5 cm, 2 required a small skin graft. Aside from 4 cases of delayed wound healing, there were no other complications.
CONCLUSIONS: Contrary to standard flaps, relaxing incisions, and galea scoring techniques, this novel procedure harnesses the body’s natural regenerative capabilities to achieve a minimally invasive closure of complex wounds without additional scars.