TIPS AND TECHNIQUES

A New Useful and Renewable Tie-Over Dressing Method

Using Package Bands and Bra Hooks
Fatih Doğan, MD, İrfan Özyazgan, MD, and Teoman Eskitaşçıoğlu, MD

Abstract: The purposes of the tie-over dressing are to secure a skin

graft toward the wound bed to avoid complications such as fluid or
blood accumulation and to prevent graft movements over the wound
bed. When there is a concern of uneventful graft take because of
infection or blood accumulation underneath the graft, it is necessary
to check the status of the graft at the postoperative first and
subsequent days. Therefore, an ideal tie-over dressing method
should not only ensure adequate immobilization and pressure but
also be able to be renewed simply and quickly. We developed a new
tie-over dressing method by using bra hooks and packing rubber
bands to solve these problematic issues.
Key Words: bra hook, package band, tie-over dressing
(Ann Plast Surg 2006;57: 348 –349)

T ie-over dressing is frequently used in plastic surgery to

ensure the adherence of a skin graft to the wound bed. The
traditional technique is based on the application of long silk
FIGURE 1. Grafted area on the deltoid region. Bra hooks are
placed peripherally on intact skin.

sutures along the circumference of the graft that are tied over
impregnated nonadherent tulle gras filled with a bolus of
fluffy gauze. The dressing is usually left in place for approx-
imately 5 days. The purposes of the tie-over dressing are to
secure a skin graft toward the wound bed to avoid compli-
cations such as fluid or blood accumulation and to prevent
graft movements over the wound bed.
When there is a concern of uneventful graft take be-
cause of infection or blood accumulation underneath the graft
due to clinical (ie, a graft over a muscle) or pharmacological
(ie, use of anticoagulants or antiaggregants) reasons, it is
necessary to check the status of the graft at the postoperative
first and subsequent days. In this way, it is possible to see and
solve the problems so that complications can be prevented
before complete graft lost occurs. Therefore, an ideal tie-over
dressing method should not only ensure adequate immobili-
zation and pressure but also be able to be renewed simply and
quickly. We developed a new tie-over dressing method by
FIGURE 2. Completed tie-over dressing using defined method.
Received February 13, 2006, and accepted for publication February 24, 2006.
From the Department of Plastic and Reconstructive Surgery, Erciyes Uni-
versity, Faculty of Medicine, Kayseri, Turkey. using bra hooks and packing rubber bands to solve these
Reprints: Fatih Doğan, MD, Erciyes University, Faculty of Medicine, Depart- problematic issues.
ment of Plastic and Reconstructive Surgery, 38039, Melikgazi, Kayseri, In this new method, skin stapler or regular sutures are
Turkey. E-mail: fdogan@erciyes.edu.tr.
Copyright © 2006 by Lippincott Williams & Wilkins
used to staple the graft circumferentially after adjustment of
ISSN: 0148-7043/06/5703-0348 the graft to the skin defect, and then, the underneath area of
DOI: 10.1097/01.sap.0000218634.91706.f3 the graft is irrigated with saline, as in the normal procedure.

348 Annals of Plastic Surgery • Volume 57, Number 3, September 2006

Annals of Plastic Surgery • Volume 57, Number 3, September 2006
Following this, the presterilized bra hooks are reciprocally
fixed onto the intact skin surrounding the grafted wound
using silk sutures (Fig. 1). The bolus dressing is placed over
the nonadhering tulle gras covering the graft. The rubber
bands are hitched to the bra hooks reciprocally crossing over
the bulky dressing. Crossing the bands to another bra hook
tightens the bands as much as possible when greater pressure
is required (Fig. 2). Different-sized bands and bra hooks may
be used for different-sized grafted wounds.
This new method has been performed in our clinic to
ensure contact between the graft and the bed, with no
discomfort to the patient, and the dressing has been re-
placed until the graft take is completed in previously
mentioned risky situations. We believe that the elasticity
© 2006 Lippincott Williams & Wilkins
Tie-Over Dressing Using Package Bands and Bra Hooks
of the bands offers an additional important advantage of
continual pressure application over the dressing. This pres-
sure might easily be lost when silk sutures are used once to
squeeze the bolus.
The predominant advantage of this new method is the
fact that the materials used are easily available and even less
expensive than silk sutures, which are used in conventional
tie-over dressing techniques. The ability to complete this
tie-over dressing by 1 physician offers another obvious ad-
vantage of this new method: assistance is needed while
knotting the sutures over bolus in ordinary dressings.
In conclusion, we describe a new method which is
effective, easy to apply, inexpensive, and useful for skin graft
applications when tie-over dressing is found necessary.
349