With reference to a case report “Cable ties: poor man's top closure system”: 1
We read the case report with a lot of interest. 1 The efforts put in by the authors to deal with difficult scalp defect by innovative use of cable ties in a poor patient is really appreciable. Our compliments to the authors for the results they have achieved.
There are a few observations that we thought would be reasonable to bring to the attention of the authors, namely the following:
The wound appears to be inadequately debrided ( Fig. 1 ).
Cable tie bites are placed with 3–0 Ethilon 1 cm apart on apparent unhealthy margins ( Fig. 1 ), which may cause further necrosis of the edges with the possibility of ending up with a larger defect than the original defect. The fact that this is likely to result in a poor scar and alopecia cannot be overemphasized.
The protocol the authors used for tightening the cable ties is not mentioned. 2 Needless to say, inadequate tightening will defeat the purpose, while excessive tightening will cause necrosis of edges and therefore again defeat the purpose.
The presence of white substance adjacent to the sutured end of the cable tie that looks like cyanoacrylate glue (as seen in Fig. 2 ) is unexplained by the authors.
Whether the cable tie approximated wound edges were sutured secondarily 3 or whether it was left to heal with secondary intention is not mentioned ( Fig. 3 ). The authors state that after approximation the ties were left in situ for 1 week. We are curious to know if any wound gaping resulted after the ties were removed.
The type of dressing used by the authors to prevent desiccation of exposed bones is not mentioned; bringing in the flaps over a dead bone is not going to solve the problem. It would only result in development of a discharging sinus and risk of infection permeating down the intracranial structures as a result perhaps.
Fig. 1.
Postdebridement wound with cable ties in situ.
Fig. 2.
Sutured ties in situ with cyanoacrylate glue.
Fig. 3.
Approximated wound edges.
We would really appreciate the authors' response to our above-mentioned queries, which would help us in understanding the technique better and execute the same whenever the need be in our setup.
Thank you.
Funding Statement
Funding None.
Footnotes
Conflict of Interest None declared.
References
- 1.Choudhary A N, Kumar S. Cable ties: poor man's top closure system. Indian J Plast Surg. 2023;56(02):182–184. doi: 10.1055/s-0043-1761179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Barnea Y, Gur E, Amir A, Leshem D, Zaretski A, Miller E, Shafir R, Weiss J. Delayed primary closure of fasciotomy wounds with Wisebands, a skin- and soft tissue-stretch device. Injury. 2006;37(06):561–566. doi: 10.1016/j.injury.2006.02.056. [DOI] [PubMed] [Google Scholar]
- 3.Lei Y, Liu L, Du S H, Zong Z W, Zhang L Y, Guo Q S. The use of a skin-stretching device combined with vacuum sealing drainage for closure of a large skin defect: a case report. J Med Case Rep. 2018;12(01):264. doi: 10.1186/s13256-018-1779-8. [DOI] [PMC free article] [PubMed] [Google Scholar]