Reaching closure with skin stretching: Applications in the diabetic foot

At the present time, there are no evidence-based protocols outlining the use of the Sure-Closure Skin Stretching System on diabetic, neuropathic wounds. Ideally, surgical correction of the precipitating deformity and appropriate shoe gear accommodation should be performed concomitantly with skin stretching (as indicated) to achieve an optimal long-term result. For several years, we have used the Sure-Closure device as an adjunctive treatment for diabetic-foot wound closure, and believe that, ultimately, this device more likely will be used in a clinical setting. In this manner, a patient with an open wound may, under aseptic conditions, be sequestered for a period of 1 to 2 hours during a clinical visit to allow for skin stretching. This procedure may be carried out two or three times weekly until closure is achieved. Mechanically assisted delayed primary closure is a relatively new category of wound closure; however, this device is by no means a panacea. Appropriate patient selection and intraoperative judgment are of critical preoperative and perioperative importance when employing this technique. Currently, we are completing a clinical trial comparing mechanically assisted delayed primary-wound closure to traditional treatment and off-loading in a population of high-risk diabetic patients. We believe that this project will better elucidate the relative indications and contraindications with what may be a very effective tool for the diabetic foot specialist.