Closure of difficult wounds by external tissue expansion.

 The open nonhealing wound is a persistent challenge to physicians. Infections, foreign bodies, osteomyelitis, and skin coverage of repaired structures remain problems. As the body ages, the elderly are prone to the development of pressure sores and foot ulcers, particularly patients with diabetes. Many elderly patients will have comorbid conditions making closure of these wounds difficult. The authors have more than 100 combined years of experience treating wounds. Throughout their long careers the authors have treated numerous wounds with various types of methods. Antibiotics were introduced during World War II; specially developed colloidal dressings, growth factors, and negative pressure wound therapy were introduced to expedite epithelial coverage of wounds. The plastic surgery field was developed through the introduction of flaps to close wounds. In the last 12 years, we have closed most wounds with an external tissue expansion device usually in 1 to 2 weeks. A quickly closed wound improves the quality of life for the patient and reduces the cost to the healthcare system.