“Soap Scrap” Technique: A Tissue-Preserving Approach to Treating Wounds with Undermining or Pockets

Abstract

ABSTRACT This retrospective case series introduces a tissue-preserving approach to treat complicated wounds with undermined edges or wounds with pockets. Wounds with undermining or pockets are commonly encountered in clinical practice and can be difficult to manage when trying to achieve wound closure. Traditionally, epibolic edges need to be resected or cauterized with silver nitrate, whereas wound undermining or pockets need to be resected or unroofed. The method described herein consists of three components: sharp debridement of all undermined areas or inside walls of wound pockets, compression, and immobilization. Compression can be performed using multilayered compression alone, modified negative-pressure therapy, or both. Immobilization of all wound layers can be achieved using a brace, removable Cam Walker, or a cast. This article reports on 11 patients who had unfavorable upper and lower extremity wounds with undermined areas or wound pockets who were treated using this methodology. The average patient age was 73 years, and the average wound depth was 1.12 cm. The average undermined area was 1.7 (range, 0.2–5.0) cm. Wounds healed in an average of 9.1 weeks; all wounds healed between 3 and 15 weeks. This series demonstrates a novel tissue-preserving approach to treating wounds with undermining or wounds with pockets using debridement, immobilization, and compression.