Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA.
Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Arch Dermatol Res. 2022 Sep;314(7):697-703. doi: 10.1007/s00403-021-02280-5. Epub 2021 Sep 21.
Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .
削弱被认为可以改善伤口愈合效果；然而，人类缺乏关于其疗效的随机对照数据。本随机临床试验的目的是确定在任何解剖部位，对于预测术后切口长度≥3cm 的低至中度张力伤口，与不进行皮下减张的伤口闭合相比，皮下减张是否能改善疤痕美容效果。筛选了 54 名 18 岁或以上的患者，这些患者需要进行原发性线性皮肤缺损闭合，预计任何解剖部位的术后切口长度≥3cm。有 4 名患者被排除，50 名患者被纳入研究，48 名患者在随访中。将伤口分为两半，一侧随机接受不进行皮下减张或 2cm 皮下减张，另一侧接受未选择的干预。3 个月时，患者和 2 名盲法观察者使用患者和观察者疤痕评估量表（POSAS）对每个疤痕进行评估。共有 50 名患者[平均（标准差）年龄，67.6（11.5）岁；31 名（64.6%）男性；48 名（100%）白人]纳入本研究。（POSAS 观察者评分），削弱侧的平均（标准差）总分是 12.0（6.05），未削弱侧的平均（标准差）总分是 11.1（4.68）（P=0.60）。在 3 个月时，POSAS 评分患者评分部分的平均（标准差）总分在削弱侧[15.9（9.07）]和未削弱侧[13.33（6.20）]之间没有发现统计学上的显著差异。对于低至中度感知张力的伤口，在削弱伤口侧和未削弱伤口侧之间，在疤痕结局或总并发症方面没有观察到统计学上的显著差异。试验注册：临床试验.gov 标识符 NCT02289859。https://clinicaltrials.gov/ct2/show/NCT02289859。
