Pediatric Wound Closure by a Tension-Relief System

Dafna Shilo Yaacobi*, Moris Topaz, Eyal Kalish, Yehiel Hayun, Michael Gurevich, Dean Ad-El, Andrew E. Grush, Asaf Olshinka

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Surgical reconstruction in pediatric patients can often be complex. Primary wound closure is almost always the preferred technique in the reconstructive ladder; however, it is not always possible in pediatric patients. We report the pediatric use of the TopClosure Tension-Relief System, an innovative skin-stretching technique for secure primary wound closure of large defects. We modified the technique by fixating it to a protective dressing instead of the patient's skin, thus avoiding both staple scars and pain. A retrospective review of 112 patients aged 7 days to 18 years who underwent Tension-Relief System-Assisted surgery at a tertiary medical center from 2010 to 2020 was conducted. Cases included congenital deformities, traumatic wounds, burn scars, and complicated-wounds, with or without hardware or deep tissue exposure. The use of the system avoided the need for multiple surgical sessions and for local or regional flaps. The technique was simple to use, with few complications, and led to satisfactory aesthetic and functional outcomes. The findings support using the technique in children and adolescents with challenging tension wounds. Herein, we report on our experience with the Tension-Relief System and detail four cases in which early or immediate closure was successfully achieved.

Original languageEnglish
Pages (from-to)83-88
Number of pages6
JournalSeminars in Plastic Surgery
Issue number2
StatePublished - 1 May 2022
Externally publishedYes


  • Tension-Relief System
  • TopClosure for pediatric use
  • challenging pediatric wounds
  • pediatric tension wound


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