title: A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer's skin tension lines.
abstract: BACKGROUND
  How a scar is managed postoperatively influences its cosmetic outcome. After suture removal, scars are susceptible to skin tension, which may be the trigger for hypertrophic scarring. Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring.
  
  
  METHODS
  Seventy patients who had undergone cesarean section at the Royal Brisbane and Women's Hospital were randomized to treatment and control groups. Patients in the control group received no postoperative intervention. Patients in the treatment group applied paper tape to their scars for 12 weeks. Scars were assessed at 6 weeks, 12 weeks, and 6 months after surgery using ultrasound to measure intradermal scar volume. Scars were also assessed using the International Clinical Recommendations.
  
  
  RESULTS
  Paper tape significantly decreased scar volume by a mean of 0.16 cm3, (95 percent confidence interval, 0.00 to 0.29 cm3). At 12 weeks after surgery, 41 percent of the control group developed hypertrophic scars compared with none in the treatment group (exact test, p = 0.003). In the treatment group, one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed. The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group (95 percent confidence interval, 3.6 to 66.9). Of the 70 patients randomized, 39 completed the study. Four patients in the treatment group developed a localized red rash beneath the tape. These reactions were minor and transient and resolved without medical intervention.
  
  
  CONCLUSIONS
  The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring. Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.
authors.affiliation: Occupational Therapy and Health Department, Burns, Trauma and Critical Care Research Center, Royal Brisbane and Women's Hospital, Queensland, Australia. jo-an_atkinson@health.qld.gov.au
authors.forename: Jo-An M
authors.initials: JA
authors.lastname: Atkinson
authors.forename: Kryss T
authors.initials: KT
authors.lastname: McKenna
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.forename: David J
authors.initials: DJ
authors.lastname: McGrath
authors.forename: Michael
authors.initials: M
authors.lastname: Rudd
mesh_terms: D000328:Adult; D001458:Bandages; D002585:Cesarean Section; D017439:Cicatrix, Hypertrophic / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D005355:Fibrosis; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D013718:Tensile Strength