Rapid Alignment of Collagen Fibers in the Dermis of Undermined and Not Undermined Skin Stretched with a Skin-Stretching Device

Efficacy of Skin Stretching for Burn Scar Excision: A Multicenter Randomized Controlled Trial

“…Although the mean size of our wounds was considerably larger, one should note that different selection criteria were applied. Moreover, Melis et al performed more reconstructions on the lower leg, face, and scalp (n ϭ Concerning the collagen morphology, an earlier porcine study showed that collagen bundles in the dermis realign in the direction of the mechanical force, 21 whereas in our study no realignment (difference in collagen orientation index) was found. This difference could be explained by different measurement methods (National Institutes of Health image analysis software versus Fourier analysis), by differences between humans and piglets, and by different processing of the material: in the study by Melis et al, biopsy specimens were directly frozen in liquid nitrogen and a larger biopsy specimen was harvested, which allowed fixation of the tissue in a stretched-out position.…”

“…The skin-stretching device has been described as a useful tool for the primary closure of wounds. [17][18][19][20][21][22][23][24] Melis et al showed that large defects can be closed by using this device. 20 In a clinical study, they demonstrated in 30 patients that, even though the wounds were closed under a significant amount of tension, a relatively thin scar was achieved, as was a low incidence of hypertrophic scarring (7.1 percent).…”

Influences of supra-physiological temperatures on microstructure and mechanical properties of skin tissue

“…We observed that the collagen fibers changed from a random pattern in the original tissue to the alignment in parallel with the loading direction in the stretched tissue. It is generally accepted that the changes in the direction of collagen fibers can strengthen the skin mechanical behavior [32]. The specimens heated at temperatures of 45 • C and 50 • C showed similar changes in collagen fiber alignment as those heated at 37 • C (data not shown here for brevity).…”

“…The stress-strain curves of rabbit skin with different thermal damages (i.e., heated for 10 min at 37 • C, 45 • C, 50 • C, 60 • C and 70 • C, respectively) show that skin stiffness decreased with increasing temperatures, primarily due to the change in the structure of collagen fibers [32]. The multi-scale structure of skin was introduced to explain the macro mechanical behavior of skin tissue.…”

Long-Term Results of Wounds Closed under a Significant Amount of Tension

“…The technique of skin stretching for primary closure using significant tension with the device is now routinely used in plastic surgery and has been described by us in detail in previous reports. [2][3][4] So far, little has been reported about longterm functional and aesthetic outcome of wounds closed under tension. Therefore, we present our long-term follow-up study.…”