Reconstruction of complicated scalp defect via skin traction.

Management of an open wound is a problem frequently faced, with skin defects that cannot be closed primarily. Functional and aesthetic outcome could be improved if primary approximation of skin in these large defects were possible. Primary closure may be assisted using the viscoelastic properties of the skin. The viscoelastic properties of mechanical creep and stress relaxation in the skin were described more than 40 years ago. If skin is stretched with a constant force, it will expand with time as long as it is kept under tension, a phenomenon known as mechanical creep. In contrast, if the skin is stretched to a constant distance, it will expand and lead to a decrease in the force or tension on the skin with time, a phenomenon known as stress relaxation. We have recently applied these stretching properties to close the scalp because of a defect, which previously would have undergone pericranial flap and split-thickness graft. Because of the partial necrosis of the pericranial flap, skin grafting failed. In the second stage, we inserted only the wrist part of elastic latex gloves to the wound edges in full thickness. The skin margins were advanced slowly and gently.