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      A simple and rapid method of repeated tie over dressing

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          Abstract

          Tie overdressing is commonly used to secure the graft against the raw surface and prevent loss due to of hematoma or seroma. A conventional tie over dressing with silk sutures, is a useful method of securing the graft to raw area. Refixation is difficult when repeated tie over dressings are needed. We assessed a low cost repeated tie over dressing method using sterile sample collection containers and silk suture threads in eight patients. After the graft is applied on the bed, tie-over stitches are taken, and paraffin gauze is applied over with adequate padding; the tie over sutures are passed through the container and the lid is tightened over it to complete the dressing. The lid can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. The skin graft take in all the patients was complete without any seroma or hematoma. A novel and low-cost tie over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation is reported here.

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          Most cited references11

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          The vacuum assisted closure device: a method of securing skin grafts and improving graft survival.

          Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. Consecutive case series. Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period. Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay. Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n = 32), soft tissue loss (n = 27), and fasciotomy-site coverage (n = 2). Patients were treated with the VAC (n = 34) or the bolster dressing (n = 27). The VAC group required significantly fewer repeated STSGs (1 [3%] vs 5 [19%]; P =.04). Two additional graft failures occurred in the no-VAC group, but repeated STSGs were refused by these patients. No difference was seen between the groups in age, percentage of graft take, or hospital length of stay. The no-VAC group had significantly larger grafts (mean +/- SD, 984 +/- 996 vs 386 +/- 573 cm(2); P =.006). The patients requiring repeated STSGs (n = 6) did not have significantly larger grafts than those not requiring repeated STSGs (mean +/- SD, 617 +/- 717 vs 658 +/- 857 cm(2); P =.62). No dressing-associated complications occurred in the VAC group. The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.
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            A new method of skin-graft stabilization: the Reston technique.

            We describe a new staple-on dressing technique for skin-graft stabilization, using gas-sterilized polyurethane foam as bolster material. The method has all the attributes of a satisfactory skin-graft dressing: compression to prevent hematoma and seroma, resistance to shear forces, splinting properties, and protection from the outside environment. Although we have not completed a randomized, prospective study, skin-graft "take" appears to be excellent in most cases. The technique is cost effective, and application requires a fraction of the time required for a traditional bolster dressing.
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              Redoable Tie-Over Dressing Using Multiple Loop Silk Threads

              After skin grafting, to prevent hematoma or seroma collection at the graft site, a tie-over dressing has been commonly used. However, although the conventional tie-over dressing by suture is a useful method for securing a graft site, refixation is difficult when repeated tie-over dressing is needed. Therefore, we recommend a redoable tie-over dressing technique with multiple loops threads and connecting silk threads. After the raw surface of each of our cases was covered with a skin graft, multiple loop silk thread attached with nylon at the skin graft margin. We applied the ointment gauze and wet cotton/fluffy gauze over the skin graft, then fixed the dressing by connecting cross-counter multiple loop thread with connecting silk threads. When we opened the tie-over dressing by cutting the connecting silk threads, we repeated the tie-over dressing with the same method. The skin graft was taken successfully without hematoma or seroma collection or any other complications. In conclusion, we report a novel tie-over dressing enabling simple fixation of the dressing to maintain proper tension for wounds that require repetitive fixation. Further, with this reliable method, the skin grafts were well taken.
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                Author and article information

                Journal
                Indian J Plast Surg
                Indian J Plast Surg
                IJPS
                Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Medknow Publications & Media Pvt Ltd (India )
                0970-0358
                1998-376X
                Jan-Apr 2015
                : 48
                : 1
                : 75-78
                Affiliations
                [1 ]Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta — The Medicity, Gurgaon, Haryana, India
                Author notes
                Address for correspondence: Dr. Hardeep Singh, Department of Plastic, Reconstructive and Aesthetic Surgery, Sector 38, Medanta — The Medicity, Gurgaon - 122 001, NCR, Haryana, India. E mail: drhardeepaulakh@ 123456gmail.com
                Article
                IJPS-48-75
                10.4103/0970-0358.155274
                4413495
                25991891
                e1f83fd5-cc30-4806-bb70-f8eeea619002
                Copyright: © Indian Journal of Plastic Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
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                Ideas and Innovations

                Surgery
                low cost,novel,skin graft,tie-over dressing
                Surgery
                low cost, novel, skin graft, tie-over dressing

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