title: Efficacy of skin stretching for burn scar excision: a multicenter randomized controlled trial.
abstract: BACKGROUND
  Burn survivors are frequently faced with disfiguring scars. Various techniques exist to improve scar appearance, such as laser treatment and dermabrasion. Next to that, surgical reconstruction, such as scar excision is an option. This randomized controlled trial investigates whether a larger burn scar can be excised using a skin-stretching device for wound closure, thereby optimizing use of adjacent healthy skin. This technique may allow scar excision in a one-step procedure instead of two or more steps, which is necessary for serial excision and tissue expansion.
  
  
  METHODS
  Two arms were compared: scar excision and closure by skin stretch and scar excision without additional techniques. The primary outcome measure was scar surface area reduction. In addition, complications were registered.
  
  
  RESULTS
  Fifteen patients were randomized for skin stretch and 15 patients were randomized for scar excision only. In the skin stretch group, 10 of 15 scars were completely excised compared with three of 15 in the scar excision-only group (p = 0.025). In the skin stretch group, a significantly larger reduction in scar area was achieved: 95 ± 11 percent of the scar was excised versus 78 ± 17 percent in the scar excision-only group (p = 0.003). One patient in the skin stretch group and three patients in the scar excision-only group experienced partial wound dehiscence (p = 0.598).
  
  
  CONCLUSIONS
  In burn scar reconstructions, a significantly larger reduction in scar area can be achieved using a skin-stretching device compared with scar excision with no additional techniques, without an increased risk of complications. It was shown that skin stretching is of added value for scars that cannot be excised in a one-step procedure.
authors.affiliation: Beverwijk, Amsterdam, and Groningen, The Netherlands From the Association of Dutch Burn Centers, the Department of Plastic, Reconstructive, and Hand Surgery, and the Burn Center, Red Cross Hospital; the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center; and the Department of Plastic, Reconstructive, and Hand Surgery and the Association of Dutch Burn Centers, Martini Hospital; and the Department of Plastic, Reconstructive, and Hand Surgery, VU Medical Center.
authors.forename: Pauline D H M
authors.initials: PDHM
authors.lastname: Verhaegen
authors.forename: Antoine J M
authors.initials: AJM
authors.lastname: van Trier
authors.forename: Sandra J M
authors.initials: SJM
authors.lastname: Jongen
authors.forename: Marcel
authors.initials: M
authors.lastname: Vlig
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Nieuwenhuis
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.forename: Paul P M
authors.initials: PPM
authors.lastname: van Zuijlen
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000150:complications / Q000601:surgery*; D002056:Burns / Q000150:complications / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000379:methods*; D016896:Treatment Outcome