A comparison on the scar development when done through overlapping versus approximating seams techniques - A clinical trial

Burns. 2021 Nov;47(7):1602-1607. doi: 10.1016/j.burns.2021.01.007. Epub 2021 Feb 3.


Introduction: Skin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting.

Objective: We sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars.

Methods and materials: Patients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the "approximating" technique and the other side was fixed by the "overlapping" technique with a 1-2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant.

Results: Thirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001).

Conclusion: We compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.

Keywords: Autograft; Burn; Scar; Seams technique.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Burns* / surgery
  • Cicatrix* / pathology
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Skin Transplantation / methods*
  • Transplantation, Autologous