Applying skin graft sheets transversely to manage burn patients

Abstract

Aim: The aim of this study is to determine whether the split-thickness grafts should be applied to the treatment of burn patients, parallel to the relaxed skin tension lines as described by Kraissl, which would help scarring and reduce the development of abnormal scars.

Methods: A descriptive longitudinal case series study was conducted at the Burn Unit of Health Services Simón Bolívar North Subnetwork E.S.E. of the Secretariat of Health in Bogotá, Colombia, from 1 Jan 2016 to 31 Dec 2017. A total of 138 burn patients exhibiting deep partial- or full-thickness burns involving different body regions, except for the face, were included. Burns required split-thickness skin grafts for definite wound coverage, and these were applied transversely following relaxed skin tension lines. Results were assessed according to the Vancouver Scar Scale (VSS) during a 12-month follow-up. Within this period, function was assessed by the rehabilitation unit, after which physical and functional activities were determined and splinting was implemented, as per rehabilitation protocols, to control and improve functional and physical outcomes.

Results: Based on the VSS, most patients (134) had a mean score of 5 (range: 3-7), resulting in clinically acceptable scars with no functional limitations.

Conclusion: Applying split-thickness skin grafts to cover deep partial- or full-thickness burns along relaxed skin tension lines, such as Kraissl’s lines, seems to reduce wound tension force, which constitutes one of the most predominant factors contributing to the development of abnormal scars and functional sequelae.

Keywords

Split-thickness grafts / burns / relaxed skin tension lines / hypertrophic scar / keloid / contracture

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