Comment: “Cable Ties: Poor Man's Top Closure System”

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.

Publication History

Article published online:
14 June 2024

• References

• 1 Choudhary AN, Kumar S. Cable ties: poor man's top closure system. Indian J Plast Surg 2023; 56 (02) 182-184
• 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
• 3 Lei Y, Liu L, Du SH, Zong ZW, Zhang LY, Guo QS. 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