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Microporous surgical tape in wound closure and skin grafting
MICROPOROUS
SURGICAL TAPE IN WOUND AND SKIN GRAFTING 1
CLOSURE
By PHILIP A. WEISMAN, M.D.
Attending Plastic Surgeon, Good Samaritan and Miami Valley Hospitals ; Consultant in Plastic Surgery, Wright-Patterson Air Force Base Hospital, Dayton, Ohio THE use of adhesive tape for wound closure is not new. Many of us have at times resorted to this method. However, tedious suture closure of skin remains standard practice. In the November 196o issue of the American Journal of Surgery there appeared an intriguing article entitled "Non-irritating, Multipurpose Surgical Adhesive Tape," by Dr Theodore Golden. The author, a general surgeon, described the historical background and development of a new tape 2 designed for wound closure and documented the initial clinical results. The interested reader is urged to review this article. In short, the tape was alleged to be chemically inert and nonirritating to skin ; porous so that ventilation, drainage, and evaporation are unimpaired ; highly adhesive yet removable with no residue, and sterilisable by standard methods. In January I96I we began to use this surgical tape in some minor procedures in the operating room. Encouraged by initial results, we progressed to more difficult wound closure problems. This paper presents our experiences with the tape during the following twenty months. The surgical tape was steam autoclaved in 89in. rolls along with our instruments. Occasionally narrower strips were cut for small areas. Unused portions of the rolls were repeatedly re-autoclaved. (Some difficulty has been experienced with adhesiveness of the tape following autoclaving because fibres of the backing have seemed to adhere to the adhesive. Recently clinical samples of the tape applied in strips to a paper backing have been supplied in sterile packets for use in surgery. 3 There has been no difficulty with adhesiveness, but in our hands the roll form was more convenient.) The surgical tape was first employed to close minor wounds such as those resulting from excision of a na~vus and was used in conjunction with interrupted sutures. Soon it was found possible to dispense with the cutaneous sutures altogether in many situations. However, we have continued to use buried 5/0 white silk sutures inserted in the dermis and subcutaneous tissue to align the wound, just as was customarily done with our routine suture closures. Tapes are usually applied at right angles to the wound. Holding the roll of tape in the left hand, the free end is secured to one side of the wound, the wound edges are drawn together, and the tape is secured to the other side (Fig. ~). When skin edges fall together quite readily, as in the pre-auricular region and with transverse wounds of the neck, the tape may sometimes be applied directly on and parallel 1 Presented at the meeting of the Ohio Valley Plastic Surgery Society, White Sulphur Springs, West Virginia, I8th May I962. 2 Scotch Brand Surgical Tape (microporous), a product of the Minnesota Mining and Manufacturing Co., Saint Paul 6, Minnesota. Now commercially available. 379
380
BRITISH
JOURNAL
OF
PLASTIC
SURGERY
A
B FIG. I Application of surgical tape using repeatedly autoclaved roll. A, Excision nmvi of face. Tape applied at right angles to wound in supra-orbital region and parallel to wound in preauricular region. B, On the sixth post-operative day the tape is peeled off revealing no irritation, suture marks, or adhesive residue.
A
B FIG. 2 Boy, aged 6 years. A, Appearance of chest on fourth post-operative day following excision of sixth, seventh, and eighth costal cartilages for autogenous graft in ear construction. Tapes removed at two weeks. Primary healing. B, Appearance two months post-operatively.
to the wound. The skin must be dry. Pressure is momentarily made over the tape with a dry gauze sponge. The wound is dressed with a wet gauze pad over which is applied a routine pressure dressing. The tapes are removed in one to two weeks (Fig. 2). The surgical tape has proved advantageous in dosing skin flap wounds because it avoids the tiny areas of ischmmia produced by sutures. The tension is distributed over a broader area (Fig. 3)-
MICROPOROUS SURGICAL TAPE IN
WOUND CLOSURE AND SKIN GRAFTING 38I
A
B Fla. 3 A, Xanthofibroma on the posterior aspect of the calf of a man weighing 200 lb. B, Rotational skin flap required to close wound. Secured with buried sutures of white silk and surgical tape. Appearance two weeks post-operatively immediately following removal of tape. Note absence of suture marks.
A
B F:G. 4 A, Appearance fourth post-operative day following combined jaw resection, radical neck dissection, and tracheotomy for carcinoma of the gingiva with invasion of mandible and lymph node metastasis. A Penrose drain was removed at twenty-four hours without disturbing the bulky compression dressing. Note good adherence of the surgical tape desp.ite serum and blood-soaked dressing. Also note ability to inspect the wound without removing the tapes. The wound has been washed immediately prior to taking this picture. The vermilion and upper portion of the lower lip were sutured. B, Appearance two months post-operatively. There is some " bow stringing" of the cervical scar, but this was due to the position of the scar and was not related to the tape closure.
BRITISH
382
A
JOURNAL
OF
B
PLASTIC
SURGERY
C
FIG. 5 A, Appearance five days after bilateral " face lift " procedure carried out under local anmsthesia and heavy sedation, a five-hour operation. The facial skin flaps were undermined nearly to the angle of the eye and the angle of the mouth and well down on to the neck. Penrose drains brought out through stab wounds in the post-auricular regions were removed in twenty-four hours. The skin flaps were secured to the deep fascia with buried sutures of 5/o white silk. The skin was closed entirely with surgical tape. B, Before. C, Seven weeks after this face-li•ng procedure in a 48-year-old school teacher.
A
B FIG. 6 Girl aged 4 years, with burn scar contracture of right arm somewhat similar to Fig. 7, A. A, Appearance forty-eight hours after preliminary release of contracture, excision of scar tissue, and suturing of upper portion of flap. The flap has been sutured with 6/o chromic catgut rather than closing it with tape, because the corrugations of the scarred skin made it unsatisfactory for tape closure. B, A fitted thick split-thickness skin graft is being applied. The four corners of the graft are first taped. T h e n the intervening graft is trimmed and taped to fit. The tapes at the four corners are then removed, the corners are trimmed, and fresh tapes are applied. A complete " t a k e " of the skin graft was achieved.
MICROPOROUS SURGICAL TAPE IN
WOUND CLOSURE AND SKIN
GRAFTING 383
In major tumour surgery of the head and neck the time-saving factor has been particularly important. The tapes have held securely in the presence of serum and blood-soaked dressings (Fig. 4). Eventually we developed sufficient confidence in the security of the tape to justify its use in major cosmetic surgery (Fig. 5). Surgical tape has been particularly helpful in skin grafting. In recent years, to reduce the risk of bleeding beneath the graft, we have increasingly favoured twostage procedures, excising in an initial operation and applying the graft approximately forty-eight to seventy-two hours later (Figs. 6, A and 9). In the interim the wound is protected with a non-adhering dressing which is unchanged until the time of grafting. However, although excellent h~emostasis is obtained,
A
B FIG. 7 A, Boy, aged 289 years, with b u r n scar contracture of right arm. B, Appearance of flexor aspect of elbow on fifteenth post-operative day after skin grafting. T h e surgical tapes have been peeled off the proximal two-thirds of the graft and have carried away with them the desquamating superficial epidermis, revealing light pink, viable skin graft accurately healed to surrounding skin. On the distal third of the wound are seen the original tapes still in place over more darkly photographing peeling epidermis.
nevertheless, in the past, with the suturing on of the graft, each passage of the suture needle incurred the risk of a small hmmatoma beneath the graft. With the taping technique this risk has been eliminated (Fig. 6, B). The speed of application, the immobilisation provided by the inelastic tape backing in continuity with the surrounding skin, the ability to inspect the graft through the semi-transparent tape, and the elimination of the need for suture removal have been most advantageous (Fig. 7). The tape has proved satisfactory in dirty as well as clean wounds (Fig. 8). Although thicker discharges do not seem to pass through the pores of the tape, nevertheless by allowing small spaces between the tapes, discharge is allowed to come out into the dressing. The tapes have usually remained secure in the presence of discharge. At the initial dressing, secretions which may have accumulated at the wound edge beneath the tape are readily milked out between the tapes. The tape h a s proved non-irritating to young epithelium, for instance, on healed seconddegree burn areas surrounding third-degree burns (Fig. 8, s).
384
BRITISH
JOURNAL
OF
A
B
PLASTIC
SURGERY
C
Fie. 8 A, Boy, aged i8 months, referred for skin grafting nearly six weeks after third degree burns of shoulder and chest caused by boiling water. B, Appearance five days after skin grafting. T h e fitted graft was secured entirely with surgical tape. Note ability to inspect the graft through the semi-transparent tape. Tapes applied to young epithelium surrounding the third degree areas were well tolerated without irritation. C, Appearance thirteen days after grafting showing complete " take " of the graft.
A
B
C
FIG. 9 Boy aged 9, with full skin thickness burn of face caused by gasoline explosion. A, Appearance immediately following debridement. B, Three days after debridement fitted, thick split-thickness skin grafts were applied and secured with 6/o chromic catgut sutures along the smile lines and about the eyelids and with surgical tape at the periphery. Appearance six days after skin grafting. C, Appearance one month after skin grafting.
MICROPOROUS
SURGICAL TAPE
IN
WOUND
CLOSURE AND
SKIN
GRAFTING
385
The skin-grafted wounds have been dressed with wet gauze pads followed by a fluffy bolus dressing secured by additional surgical tape rather than by tie-over sutures. The part with its bolus dressing has been additionally dressed and immobilised with bulky dressings and plaster splints where indicated. Taping of skin grafts was combined with suture technique in areas where security of the tape was not reliable, such as about the mouth and eyelids (Fig. 9)Sterile surgical tape has offered an additional advantage in the dressing of donor site wounds, since pressure dressings can be applied immediately instead of only at the end of the operation. The tape has worked well in the closure of fullthickness skin graft donor site wounds. DISCUSSION A twenty-months' experience with surgical tape in wound closure and skin grafting has brought out the following unfavourable and favourable considerations : Unfavourable Considerations.mi. Surgical tape closure does not produce eversion of skin edges. However, subcutaneous and subdermal sutures in combination with the tape do produce this effect. Moreover, inverted mattress sutures can be used with the tape. 2. Does not stick to wet skin. 3. Not usable in awkward positions such as the nostril border. 4- Can be removed by patient. (One patient, a rather nervous 9-year-old girl, responding to itching of her forehead wound beneath a head dressing, inserted her fingers beneath the dressing and scratched off some of the tape, producing slight separation of wound edges.) 5. Small wound-edge separations and sometimes secretions may remain hidden beneath the tape. 6. Increased possibility for misalignment of skin edges, usually an error in technique. 7. Cannot be considered as secure as suture closure, and we continue to place an occasional interrupted suture along with the tape for better alignment and added security. 8. Lack of uniformity of adhesiveness after autoclaving (this difficulty will probably be overcome by the manufacturer, either in the processing or method of sterile packaging). Favourable Considerations.mi. Time saving, both at surgery and postoperatively, in avoiding the need for sutures and their removal. z. Essentially inert and non-irritating (Dr John Gaisford states that he has had one patient who experienced a sensitivity-type reaction to the tape). 3. Expense-saving. Less expensive than suture material. 4. Avoidance of needle puncture, with risk of bleeding, especially applicable to skin grafts. 5. Absence of suture marks. 6. Elimination of discomfort and annoyance of suture removal (particularly with children). 7. The taped wound is washable with soap and water without impairing security. 8. Does not stick to rubber gloves.
386
BRITISH
JOURNAL
OF
PLASTIC
SURGERY
9. No gummy adhesive residue on skin after removal. IO. Allegedly non-irritating with radiation therapy (unlike zinc oxide adhesive tapes). I z. The adhesive does not creep, melt at body temperature, or enter pores or hair follicles. I2. Usually not dislodged by secretions. I3. Does not require anmsthetic for application of skin graft. (In one case a drumload of skin was removed from the thigh under local anmsthesia and applied to a raw area on the chest without anmsthesia, with perfect approximation of wound and graft edges.) z4. Provides a flat plane which aids in alignment of wound edges. z5. Does not adhere strongly to hair. I6. Can be left undisturbed for prolonged periods, for example, under a plaster cast. I7. Translucent, allowing some wound inspection. I8. Removable by patient, so that an office visit is at times eliminated. I9. Non-stretchy, making excellent backing for skin grafts, with the backing in continuity with the surrounding skin. 20. Easy to tear. 2z. Porous, allowing evaporation, drying, and cooling. 22. Sterilisable by steam autoclaving. As with any new technique, success requires patience, trial and error, and attention to detail. One cannot compare first attempts with tape to suturing technique which is second nature. Difficulties encountered initially are soon overcome. Persistence and ingenuity are requisite to a fair trial of its use. SUMMARY Experiences with microporous surgical tape in wound closure and skin grafting during a twenty months' trial period are reported. Many compelling advantages of adhesive tape over suture for wound closure suggest continued use of the tape and refinement of the techniques of manufacture, packaging, and application. REFERENCE GOLDEN, T. (I960). Amer. ,7. Surg., Ioo, 789 . Submitted for publication, January 1963.
SURGICAL TAPE IN WOUND AND SKIN GRAFTING 1
CLOSURE
By PHILIP A. WEISMAN, M.D.
Attending Plastic Surgeon, Good Samaritan and Miami Valley Hospitals ; Consultant in Plastic Surgery, Wright-Patterson Air Force Base Hospital, Dayton, Ohio THE use of adhesive tape for wound closure is not new. Many of us have at times resorted to this method. However, tedious suture closure of skin remains standard practice. In the November 196o issue of the American Journal of Surgery there appeared an intriguing article entitled "Non-irritating, Multipurpose Surgical Adhesive Tape," by Dr Theodore Golden. The author, a general surgeon, described the historical background and development of a new tape 2 designed for wound closure and documented the initial clinical results. The interested reader is urged to review this article. In short, the tape was alleged to be chemically inert and nonirritating to skin ; porous so that ventilation, drainage, and evaporation are unimpaired ; highly adhesive yet removable with no residue, and sterilisable by standard methods. In January I96I we began to use this surgical tape in some minor procedures in the operating room. Encouraged by initial results, we progressed to more difficult wound closure problems. This paper presents our experiences with the tape during the following twenty months. The surgical tape was steam autoclaved in 89in. rolls along with our instruments. Occasionally narrower strips were cut for small areas. Unused portions of the rolls were repeatedly re-autoclaved. (Some difficulty has been experienced with adhesiveness of the tape following autoclaving because fibres of the backing have seemed to adhere to the adhesive. Recently clinical samples of the tape applied in strips to a paper backing have been supplied in sterile packets for use in surgery. 3 There has been no difficulty with adhesiveness, but in our hands the roll form was more convenient.) The surgical tape was first employed to close minor wounds such as those resulting from excision of a na~vus and was used in conjunction with interrupted sutures. Soon it was found possible to dispense with the cutaneous sutures altogether in many situations. However, we have continued to use buried 5/0 white silk sutures inserted in the dermis and subcutaneous tissue to align the wound, just as was customarily done with our routine suture closures. Tapes are usually applied at right angles to the wound. Holding the roll of tape in the left hand, the free end is secured to one side of the wound, the wound edges are drawn together, and the tape is secured to the other side (Fig. ~). When skin edges fall together quite readily, as in the pre-auricular region and with transverse wounds of the neck, the tape may sometimes be applied directly on and parallel 1 Presented at the meeting of the Ohio Valley Plastic Surgery Society, White Sulphur Springs, West Virginia, I8th May I962. 2 Scotch Brand Surgical Tape (microporous), a product of the Minnesota Mining and Manufacturing Co., Saint Paul 6, Minnesota. Now commercially available. 379
380
BRITISH
JOURNAL
OF
PLASTIC
SURGERY
A
B FIG. I Application of surgical tape using repeatedly autoclaved roll. A, Excision nmvi of face. Tape applied at right angles to wound in supra-orbital region and parallel to wound in preauricular region. B, On the sixth post-operative day the tape is peeled off revealing no irritation, suture marks, or adhesive residue.
A
B FIG. 2 Boy, aged 6 years. A, Appearance of chest on fourth post-operative day following excision of sixth, seventh, and eighth costal cartilages for autogenous graft in ear construction. Tapes removed at two weeks. Primary healing. B, Appearance two months post-operatively.
to the wound. The skin must be dry. Pressure is momentarily made over the tape with a dry gauze sponge. The wound is dressed with a wet gauze pad over which is applied a routine pressure dressing. The tapes are removed in one to two weeks (Fig. 2). The surgical tape has proved advantageous in dosing skin flap wounds because it avoids the tiny areas of ischmmia produced by sutures. The tension is distributed over a broader area (Fig. 3)-
MICROPOROUS SURGICAL TAPE IN
WOUND CLOSURE AND SKIN GRAFTING 38I
A
B Fla. 3 A, Xanthofibroma on the posterior aspect of the calf of a man weighing 200 lb. B, Rotational skin flap required to close wound. Secured with buried sutures of white silk and surgical tape. Appearance two weeks post-operatively immediately following removal of tape. Note absence of suture marks.
A
B F:G. 4 A, Appearance fourth post-operative day following combined jaw resection, radical neck dissection, and tracheotomy for carcinoma of the gingiva with invasion of mandible and lymph node metastasis. A Penrose drain was removed at twenty-four hours without disturbing the bulky compression dressing. Note good adherence of the surgical tape desp.ite serum and blood-soaked dressing. Also note ability to inspect the wound without removing the tapes. The wound has been washed immediately prior to taking this picture. The vermilion and upper portion of the lower lip were sutured. B, Appearance two months post-operatively. There is some " bow stringing" of the cervical scar, but this was due to the position of the scar and was not related to the tape closure.
BRITISH
382
A
JOURNAL
OF
B
PLASTIC
SURGERY
C
FIG. 5 A, Appearance five days after bilateral " face lift " procedure carried out under local anmsthesia and heavy sedation, a five-hour operation. The facial skin flaps were undermined nearly to the angle of the eye and the angle of the mouth and well down on to the neck. Penrose drains brought out through stab wounds in the post-auricular regions were removed in twenty-four hours. The skin flaps were secured to the deep fascia with buried sutures of 5/o white silk. The skin was closed entirely with surgical tape. B, Before. C, Seven weeks after this face-li•ng procedure in a 48-year-old school teacher.
A
B FIG. 6 Girl aged 4 years, with burn scar contracture of right arm somewhat similar to Fig. 7, A. A, Appearance forty-eight hours after preliminary release of contracture, excision of scar tissue, and suturing of upper portion of flap. The flap has been sutured with 6/o chromic catgut rather than closing it with tape, because the corrugations of the scarred skin made it unsatisfactory for tape closure. B, A fitted thick split-thickness skin graft is being applied. The four corners of the graft are first taped. T h e n the intervening graft is trimmed and taped to fit. The tapes at the four corners are then removed, the corners are trimmed, and fresh tapes are applied. A complete " t a k e " of the skin graft was achieved.
MICROPOROUS SURGICAL TAPE IN
WOUND CLOSURE AND SKIN
GRAFTING 383
In major tumour surgery of the head and neck the time-saving factor has been particularly important. The tapes have held securely in the presence of serum and blood-soaked dressings (Fig. 4). Eventually we developed sufficient confidence in the security of the tape to justify its use in major cosmetic surgery (Fig. 5). Surgical tape has been particularly helpful in skin grafting. In recent years, to reduce the risk of bleeding beneath the graft, we have increasingly favoured twostage procedures, excising in an initial operation and applying the graft approximately forty-eight to seventy-two hours later (Figs. 6, A and 9). In the interim the wound is protected with a non-adhering dressing which is unchanged until the time of grafting. However, although excellent h~emostasis is obtained,
A
B FIG. 7 A, Boy, aged 289 years, with b u r n scar contracture of right arm. B, Appearance of flexor aspect of elbow on fifteenth post-operative day after skin grafting. T h e surgical tapes have been peeled off the proximal two-thirds of the graft and have carried away with them the desquamating superficial epidermis, revealing light pink, viable skin graft accurately healed to surrounding skin. On the distal third of the wound are seen the original tapes still in place over more darkly photographing peeling epidermis.
nevertheless, in the past, with the suturing on of the graft, each passage of the suture needle incurred the risk of a small hmmatoma beneath the graft. With the taping technique this risk has been eliminated (Fig. 6, B). The speed of application, the immobilisation provided by the inelastic tape backing in continuity with the surrounding skin, the ability to inspect the graft through the semi-transparent tape, and the elimination of the need for suture removal have been most advantageous (Fig. 7). The tape has proved satisfactory in dirty as well as clean wounds (Fig. 8). Although thicker discharges do not seem to pass through the pores of the tape, nevertheless by allowing small spaces between the tapes, discharge is allowed to come out into the dressing. The tapes have usually remained secure in the presence of discharge. At the initial dressing, secretions which may have accumulated at the wound edge beneath the tape are readily milked out between the tapes. The tape h a s proved non-irritating to young epithelium, for instance, on healed seconddegree burn areas surrounding third-degree burns (Fig. 8, s).
384
BRITISH
JOURNAL
OF
A
B
PLASTIC
SURGERY
C
Fie. 8 A, Boy, aged i8 months, referred for skin grafting nearly six weeks after third degree burns of shoulder and chest caused by boiling water. B, Appearance five days after skin grafting. T h e fitted graft was secured entirely with surgical tape. Note ability to inspect the graft through the semi-transparent tape. Tapes applied to young epithelium surrounding the third degree areas were well tolerated without irritation. C, Appearance thirteen days after grafting showing complete " take " of the graft.
A
B
C
FIG. 9 Boy aged 9, with full skin thickness burn of face caused by gasoline explosion. A, Appearance immediately following debridement. B, Three days after debridement fitted, thick split-thickness skin grafts were applied and secured with 6/o chromic catgut sutures along the smile lines and about the eyelids and with surgical tape at the periphery. Appearance six days after skin grafting. C, Appearance one month after skin grafting.
MICROPOROUS
SURGICAL TAPE
IN
WOUND
CLOSURE AND
SKIN
GRAFTING
385
The skin-grafted wounds have been dressed with wet gauze pads followed by a fluffy bolus dressing secured by additional surgical tape rather than by tie-over sutures. The part with its bolus dressing has been additionally dressed and immobilised with bulky dressings and plaster splints where indicated. Taping of skin grafts was combined with suture technique in areas where security of the tape was not reliable, such as about the mouth and eyelids (Fig. 9)Sterile surgical tape has offered an additional advantage in the dressing of donor site wounds, since pressure dressings can be applied immediately instead of only at the end of the operation. The tape has worked well in the closure of fullthickness skin graft donor site wounds. DISCUSSION A twenty-months' experience with surgical tape in wound closure and skin grafting has brought out the following unfavourable and favourable considerations : Unfavourable Considerations.mi. Surgical tape closure does not produce eversion of skin edges. However, subcutaneous and subdermal sutures in combination with the tape do produce this effect. Moreover, inverted mattress sutures can be used with the tape. 2. Does not stick to wet skin. 3. Not usable in awkward positions such as the nostril border. 4- Can be removed by patient. (One patient, a rather nervous 9-year-old girl, responding to itching of her forehead wound beneath a head dressing, inserted her fingers beneath the dressing and scratched off some of the tape, producing slight separation of wound edges.) 5. Small wound-edge separations and sometimes secretions may remain hidden beneath the tape. 6. Increased possibility for misalignment of skin edges, usually an error in technique. 7. Cannot be considered as secure as suture closure, and we continue to place an occasional interrupted suture along with the tape for better alignment and added security. 8. Lack of uniformity of adhesiveness after autoclaving (this difficulty will probably be overcome by the manufacturer, either in the processing or method of sterile packaging). Favourable Considerations.mi. Time saving, both at surgery and postoperatively, in avoiding the need for sutures and their removal. z. Essentially inert and non-irritating (Dr John Gaisford states that he has had one patient who experienced a sensitivity-type reaction to the tape). 3. Expense-saving. Less expensive than suture material. 4. Avoidance of needle puncture, with risk of bleeding, especially applicable to skin grafts. 5. Absence of suture marks. 6. Elimination of discomfort and annoyance of suture removal (particularly with children). 7. The taped wound is washable with soap and water without impairing security. 8. Does not stick to rubber gloves.
386
BRITISH
JOURNAL
OF
PLASTIC
SURGERY
9. No gummy adhesive residue on skin after removal. IO. Allegedly non-irritating with radiation therapy (unlike zinc oxide adhesive tapes). I z. The adhesive does not creep, melt at body temperature, or enter pores or hair follicles. I2. Usually not dislodged by secretions. I3. Does not require anmsthetic for application of skin graft. (In one case a drumload of skin was removed from the thigh under local anmsthesia and applied to a raw area on the chest without anmsthesia, with perfect approximation of wound and graft edges.) z4. Provides a flat plane which aids in alignment of wound edges. z5. Does not adhere strongly to hair. I6. Can be left undisturbed for prolonged periods, for example, under a plaster cast. I7. Translucent, allowing some wound inspection. I8. Removable by patient, so that an office visit is at times eliminated. I9. Non-stretchy, making excellent backing for skin grafts, with the backing in continuity with the surrounding skin. 20. Easy to tear. 2z. Porous, allowing evaporation, drying, and cooling. 22. Sterilisable by steam autoclaving. As with any new technique, success requires patience, trial and error, and attention to detail. One cannot compare first attempts with tape to suturing technique which is second nature. Difficulties encountered initially are soon overcome. Persistence and ingenuity are requisite to a fair trial of its use. SUMMARY Experiences with microporous surgical tape in wound closure and skin grafting during a twenty months' trial period are reported. Many compelling advantages of adhesive tape over suture for wound closure suggest continued use of the tape and refinement of the techniques of manufacture, packaging, and application. REFERENCE GOLDEN, T. (I960). Amer. ,7. Surg., Ioo, 789 . Submitted for publication, January 1963.