Effectiveness of double tie-over dressing compared with bolster dressing

Abstract

Background: Skin grafting is a commonly performed operation in plastic and reconstructive surgery. The tie-over dressing is an effective technique to secure the grafted skin by delivering persistent downward pressure. However, if an additional dressing is required due to incomplete graft healing, the process of re-implementing the tie-over dressing may be frustrating for both patients and surgeons. Therefore, we introduce the double tie-over dressing, which readily allows for an additional tie-over dressing after the first dressing, and we present a comparison of its effectiveness with that of the simpler bolster dressing.

Methods: Of 128 patients with a skin defect, 69 received a double tie-over dressing and 59 patients received a simple bolster dressing. Using the independent t-test, the mean healing time, which was defined as the mean time it took for the wound to heal completely so that no additional dressing was required and it was washable with tap water, was compared between the 2 groups in both the head and neck region and in other areas.

Results: The mean healing time for the head and neck region in the double tie-over dressing group was 9.19±1.78 days, while it was 11.05±3.85 days in the bolster dressing group. The comparison of the 2 groups by the independent t-test revealed a P-value of 0.003 for the mean healing time.

Conclusions: In the head and neck area, the double tie-over dressing required less time to heal than the simple bolster dressing.

Keywords: Bandages; Dermatologic surgical procedures; Occlusive dressings; Skin transplantation; Wounds and injuries.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.. A traumatic skin defect on the index finger

(A) An image that was taken after debridement of the wound bed. (B) The double tieover dressing was made by creating a knot with 2 strands of long silk threads on each end. (C, D) A non-adherent dressing with betadine-soaked cotton balls was placed, and only 1 strand from each knot was tied over, leaving the other strand for an additional tie-over dressing if needed after removing the first dressing.

Fig. 2.. A basal cell carcinoma on the cheek

(A, B) The basal cell carcinoma was located on the right cheek just below the temple. We designated a safety margin of 3 mm. (C) The defect margin was proven to be cancer-free by frozen biopsy. (D) A full-thickness skin graft was performed with a double tie-over dressing. (E) A month after the operation, focal skin pigmentation with elevated margin of the graft was observed, but (F) all issues had satisfactorily resolved by 6 months.