Investigating the Impact of Wound Edge Approximation with Skin Grafting on Hypertrophic Scar Reduction: A Randomized Controlled Clinical Trial.

ABSTRACT

In modern burn care, the focus extends beyond mere patient survival to encompass long-term functional and cosmetic outcomes. Research suggests that the technique and manner of suturing during skin grafting play a significant role in scar formation. This study aimed to explore the effectiveness of wound edge approximation with skin grafting compared to the conventional approach, where the graft edge exclusively interacts with the wound edge, in reducing hypertrophic scar development. Seventy-four burn unit patients eligible for grafting were randomly allocated into two groups those receiving grafts with overlapping edges (Group A) and those receiving grafts with edges tailored to the burn wound (Group B). Evaluation of graft sites occurred immediately post-surgery and at 1 and 6 months post-operatively using the standardized Vancouver Scar Scale (VSS) administered by trained surgeons. The findings of this study revealed that there was no statistically significant difference between the two examined groups regarding the average duration of hospitalization and the mean thickness of wounds (P>0.05). Similarly, the mean scores for pain, vascular index, and pigmentation index immediately post-surgery, at 1 month, and 6 months later, as well as the scar height index and flexibility immediately and at 1 month post-surgery, and the Vancouver Scar Scale index at the study's conclusion, showed no significant variation between the two groups (P>0.05). However, at the 6-month follow-up, the mean scar height score (P=0.004) in the overlapping group and the mean flexibility score (P=0.017) in the non-overlapping group were significantly lower compared to the respective alternative group. This indicates a notable improvement in scar height and wound flexibility in the overlapping group over the non-overlapping group after 6 months.