title: Short-term effects of vacuum massage on epidermal and dermal thickness and density in burn scars: an experimental study.
abstract: BACKGROUND
  Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling.
  
  
  METHODS
  A one group experimental study was performed. Patients with burn scars on upper extremities, lower extremities, and trunk were recruited for participation in this study. The DUB®cutis 22 MHz ultrasound scanner was used to assess thickness and density of the epidermal and dermal skin layers. After baseline measurements, vacuum massage was performed according to a pre-defined protocol. Measurements were carried out at 5 min, 30 min, 1 h, and 2 h post-intervention.
  
  
  RESULTS
  Thirteen scar sites from 9 different patients were investigated. In 8 out of the 13 scar sites, a disruption of the epidermis was noticed after the vacuum massage. Five minutes after the intervention, epidermal density decreased statistically significantly (p = .022) and dermal thickness increased (p = .018). Both changes lasted for more than 1 h, but after 2 h, the changes were no longer statistically significant. Dermal density decreased significantly (p = .048) immediately after the intervention, and this decrease was still present after 2 h (p = .011).
  
  
  CONCLUSIONS
  Preliminary results show that the disruption of the epidermis may indicate that vacuum massage could be able to actually breach the skin barrier. The statistically significant changes in the dermal layers could suggest an increased ECM production after vacuum massage.
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium ; Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
authors: Jill
authors: 0000-0001-6383-2961
authors: J
authors: Meirte
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium.
authors: Peter
authors: P
authors: Moortgat
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium ; KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.
authors: Mieke
authors: M
authors: Anthonissen
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium ; Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium.
authors: Koen
authors: K
authors: Maertens
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium ; ZNA Stuivenberg, Burn Center, Antwerp, Belgium.
authors: Cynthia
authors: C
authors: Lafaire
authors: OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium ; ZNA Stuivenberg, Burn Center, Antwerp, Belgium.
authors: Lieve
authors: L
authors: De Cuyper
authors: Department of Antwerp Surgical Training Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium.
authors: Guy
authors: G
authors: Hubens
authors: Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
authors: Ulrike
authors: U
authors: Van Daele
keywords: Burn; Dermal density; Dermal thickness; Scars; Vacuum massage