Wound closure by Tye-Raps: An Innovative top closure Dr.Imran Ahmad Professor and chairman Deptt of plastic surgery ,jnmc,amu,aligarh

1. Dr. Imran Ahmad
Professor and Chairman
Department of Plastic Surgery
Jawaharlal Nehru Medical College
A.M.U. Aligarh

2. o Many techniques have been applied for closure of large
skin defects like skin grafts, local flaps, tissue expansion
and free flaps
o Some of these modalities are very complex and carry
considerable morbidity due to excessive tension.
o There is prolonged hospital stay hence these are very
costly to the patient
INTRODUCTION

3. o If the skin is stretched to a constant distance in a state of stress
relaxation, it will expand, leading to a gradually reduced tension
on the skin.
o As a result of skin stretching and elongation, wound closing
tension decreases, allowing primary closure of relatively large
defects
o We felt the need for a new method that had to be effective, easily
applicable, readily available and inexpensive.
o All these conditions are fulfilled with surgical use of Ty-Raps for
delayed closure of the wounds.

4. THIS IS AN INNOVATIVE ADD ON TECHNIQUE IN THE
RECONSTRUCTIVE LADDER OF WOUND CLOSURE
Imran Ahmad, Brajesh Pathak, Sheikh Sarfraz Ali and Rajesh Maurya: Wound closure by
using Ty-Raps: An innovative top-closure; International Journal of Scientific Research.
Volume-7 | Issue-5 | May-2018 | Print ISSN No 2277 - 8179
Ty-Rap is a cable tie made of sturdy nylon tape with integrated
gear rack on one end a ratchet within a small open case

5. Top Closer
RECONSTRUCTION LADDER

6. MATERIAL
AND
METHOD

7. The inclusion criteria
o Patients having surgical wound which can not be closed
by primary suturing.
The exclusion criteria
o Unavailable/scarred surrounding skin.
o Circumferential wound of extremity.
o Unrealistic expectation of patients.
o Patient not willing for follow-up.
o Psychiatric patients.

8. o The time duration for closure of the wound.
o The time to removal of the Tye- Raps.
o The complications related to the procedure.
o Cost analysis was also calculated
Parameters Measured

9. o Out of 60 cases 48 were male and 12 female. Mean age of
presentation was 33 years (ranged between 10–64 years).
o Wound size ranged from 3-8 cm in width and 6-20 cm in
length. All wounds were closed by using the Ty-Raps

10. WOUND DISTRIBUTION

11. TECHNIQUE

12. Once the pointed tip of the Tye-Rap has been pulled through
the case and passed the ratchet, it cannot be pulled back

14. Application of Ty- Raps
6X15cm

15. OBSERVATIONS

16. o The Ty-Raps are tightened as tolerated by the patients.
This tightening procedure should repeated every 1-2 days
until complete closure of the wound is achieved
o The application and the tightening of the Ty-Raps were well
tolerated by all patients, and no procedure had to be
discontinued because of patient discomfort.
o None of the patients developed skin necrosis, and no Ty-
Raps had to be preliminary removed. All wounds (100%)
healed without complications

17. o Time to wound closure was quite variable depending on the
size and site of the wound.
o The mean time from the application of Tye to complete
closure of the wound was 7 days ( 6–10 days)
o Mean time from the application to removal of the tie was 10
days (range, 9–16 days).
o The mean cost was Indian rupees 350 for an average
wound of 15 x10cm

18. RESULTS

19. SCALP DEFECTS

20. Post Electrical Burn Scalp Defect

21. Post Electrical Burn Scalp Defect

22. High Tension Electrical Burn Defect Scalp

23. UPPER LIMB

24. Post RTA soft tissue loss in arm

25. Post abscess wound arm

26. Post NF wound

27. Post Fasciotomy 2nd
Sitting of Top Closer
In The Fore Arm

28. Wound over ant. and post Forearm

29. Electrical burn
fore arm and
hand

30. Post
Blast
Injury
Palm

31. LOWER LIMB

32. Pressure sore buttock

33. B/K Amputation Stump

34. Post Ortho Plate
Fixation Wound

35. Necrotising
fasciitis leg

36. Soft tissue loss foot

37. Post RTA defect
upper leg

38. Post fasciotomy wound leg

39. Soft tissue loss foot

40. Softtissuedefectsole

41. Post RTA soft tissue defect dorsum of foot

42. AVULSION INJURY
SOLE

43. AVULSION HEEL AND
AMPUTATION FORE FOOT

44. CONCLUSION
o This system allows closure of wounds without causing ischemia & necrosis.
o Ty-Raps closure of wounds is an alternative to skin grafts, skin flaps, tissue
expanders or other expensive devices.
o This technique may help to secure the wound closure with minimal scarring
and no donor site morbidity.
o An innovative and simple use of Tye-Raps for closure of wounds in gradual
and controlled manner.