PMC3375424_01
a SCC of the left distal leg. b The TopClosure  3S System was applied in a noninvasive manner. c-d Following surgery, the TopClosure  3S System was applied over the dressings to relieve tension and secure wound closure. e Complete wound closure with satisfactory aesthetic scar
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Fig3
A 62-year-old man presented with a 3 x 2 cm oval squamous cell carcinoma (SCC) of the left distal leg (Fig. 3a). As the defect after excision of the tumor was expected to be too big to be closed primarily, and in order to avoid skin grafting, the TopClosure  3S System was applied in a noninvasive manner for gradual stretching of the skin for 16 days until sufficient skin laxity was achieved to enable surgical resection of the lesion with primary closure (Fig. 3b). TopClosure  3S System was applied over the dressed closed wound and tightened with minimal force in order to secure wound closure by reducing tension on the suture line (Fig. 3c, d). The patient was only confirmed to bed for one postoperative day and could fully ambulate with the attached TopClosure  3S System during the rest of the preoperative and postoperative periods. Figure 3e shows complete wound closure with a satisfactory aesthetic scar.
PMC3375424_02
a Depressed lower abdominal scar following TRAM breast reconstruction. b The TopClosure  3S System was applied noninvasively prior to surgery. c Minimal blistering was observed and treated topically. During surgery, the scar was excised and wound edges were sutured in layers. d Gauze was placed over the wound with two 8-mm TopClosure  3S Systems for an additional 6-day period. e Complete wound closure with satisfactory aesthetic scar
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Fig4
TRAM breast reconstruction requested revision of the scar (Fig. 4a). The TopClosure  3S System was applied noninvasively prior to surgery in order to stretch the skin to avoid excessive tension on the newly formed scar. Two 8-mm TopClosure  3S Systems were positioned at the edge of the 7 x 8 cm depressed scar (Fig. 4b). In an attempt to reach a quick approximation, minimal blistering was observed on the underlying skin of the distal ends of the AP (Fig. 4c). TopClosure  3S Systems positioned across the incision edges for an additional 6-day period to support and secure closure, relieving tension from the wound's edges, thus enhancing the aesthetics of the scar (Fig. 4d). The blisters at the attachment site were treated topically, resulting in no residual marks. Figure 4e shows complete wound closure with a satisfactory aesthetic scar.
PMC3375424_03
a + c Wound edges were sutured in layers and stapled. b, c Two 8-mm TopClosure  3S Systems were invasively attached to the skin by staples. d Gauze was placed over the wound, and the ASs were then inserted into the L/RMs and tightened lightly. e The postoperative period was uneventful, and the wound healed well
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Fig5
Wound edges were sutured in layers and stapled (Fig. 5a + c). Two 8-mm TopClosure  3S Systems were attached invasively to the skin by staples, 3 cm from the wound edges as substitute to tension sutures (Fig. 5b, c). Gauze was placed over the wound, and the ASs were then inserted into the L/RMs and lightly tightened to support and secure closure by relieving the tension from the wound edges and distributing the stress away from the scar (Fig. 5d). The postoperative period was uneventful and the wound healed well (Fig. 5e).
PMC3375424_04
a A 12-year-old girl presented with a big congenital nevus on her right thigh. b TopClosure  (6 mm) was applied 5 days prior to excision. c-e The lesion was excised and closed in layers under tension. f, g TopClosure  was applied to secure wound closure for an additional 2 weeks following surgery. h The wound healed well, resulting in a narrow aesthetically pleasing scar
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Fig6
A 12-year-old girl presented with a congenital nevus on her right thigh (Fig. 6a). As excessive tension was expected with direct primary closure, TopClosure  (6 mm) was applied 5 days prior to excision and was gradually stretched daily (Fig. 6b). Following application of topical anesthesia, the lesion was excised and closed in layers under tension (Fig. 6c-e). In order to secure the wound closure and to improve the aesthetics of the scar, TopClosure  was applied for an additional 2 weeks following surgery (Fig. 6f, g), resulting in a narrow aesthetically pleasing scar (Fig. 6h).
PMC3375424_05
a A 29-year-old woman presented with a dehisced, infected, surgical wound following dilatation and curettage for a missed abortion that was complicated by acute massive retroperitoneal hemorrhage. b, c The wound was treated by RNPT and an 8-mm TopClosure  3S System that was fixed to the skin by staples and used to approximate wound edges. d, e The TopClosure  3S System could be cleaned together with the wound with every change of dressing. f The wound was closed by approximation of the wound edges by the TopClosure  3S System, with a final acceptable result
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Fig7
A 29-year-old woman presented with a dehisced, infected, abdominal surgical wound following dilatation and curettage for a missed abortion that was complicated by acute massive retroperitoneal hemorrhage (Fig. 7a). The wound was treated by combined regulated negative pressure-assisted wound therapy (RNPT) and an 8-mm TopClosure  3S System that was used to approximate wound edges (Fig. 7b, c). The TopClosure  3S System was attached to the skin by staples and could be cleaned together with the wound with every change of dressing (Fig. 7d, e). The wound was closed by approximation of the wound edges by the TopClosure  3S System with a final acceptable result (Fig. 7f).
PMC3375424_06
a An 88-year-old woman presented with a relatively large oval SCC of the left distal leg. b Two 8-mm TopClosure  3S Systems were applied in a noninvasive manner for gradual stretching of the skin for 12 days until skin laxity was achieved to enable surgical resection of the lesion with primary closure. c Preoperative and intraoperative cyclical skin stretching enabled complete excision of the tumor and primary edge-to-edge wound closure in layers under tension. d Complete wound closure about 6 months following surgery
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Fig8
An 88-year-old woman presented with a relatively large oval SCC (2.5 cm in diameter) of the left distal leg (Fig. 8a). As the defect after excision of the tumor was expected to be too large to be closed primarily and in order to avoid skin grafting, two 8-mm TopClosure  3S Systems were applied in a noninvasive manner for gradual stretching of the skin over a period of 12 days until the sufficient skin laxity was achieved to enable surgical resection of the lesion with primary closure (Fig. 8b). Preoperative and intraoperative skin stretching enabled complete excision of the tumor and primary edge-to-edge wound closure in layers, under tension with sutures and staples (Fig. 8c). Figure 8d shows complete wound closure.