Current approaches to surgical treatment of soft tissue defects using tissue expansion techniques

Background. The problem of closing extensive wound defects remains a challenging task in modern surgery. The increasing number of technogenic disasters, road traffic accidents, military operations, and terrorist attacks leads to a rise in patients with extensive soft tissue defects that cannot be managed using conventional suturing techniques. Objective. To analyze the current state of the problem of wound defect closure using acute and gradual tissue stretching methods based on domestic and international literature data. Materials and methods. An analysis of scientific publications on tissue distraction methods from PubMed, eLibrary, and CyberLeninka databases was conducted. The design features and clinical effectiveness of modern devices for exogenous tissue stretching were reviewed. Results. A classification of wound adaptation-repositioning devices (WARD) is presented, divided into five subgroups: needle-type, suture-type, wire-type, rod-type, and adhesive-type. The principles of operation of intratissue devices (expanders) and extratissue devices are described. The advantages and limitations of each method, as well as indications and contraindications for their use, are analyzed. Current trends in device improvement, including automated tension control and mathematical justification of distraction parameters, are highlighted. Conclusion. The method of gradual tissue distraction is a promising approach for treating patients with extensive wound defects, contributing to reduced hospitalization duration and treatment costs. Further development of new devices and algorithms adapted to individual wound defect characteristics is required.