The New Skin Stretching Device for Treatment of Limb Tension Wounds

Design:

This study is a multicenter and randomized control study with the participation of 15 major national or regional central hospitals. And the whole sample size is set to be 100 patients.

Patients who have been screened by inclusion and exclusion criteria will be randomly (non-transparent envelope) assigned to Skin Stretching Group (SS Group) or Skin Grafting Group (SG Group). Patients of both group will undergo surgical debridement for the same principle, while the Skin Stretching Device is used for the patients of SS Group for incision closure and the Skin Grafting is used for the patients of SG group for incision closure.

Outcome evaluation:

Wound and scar evaluation during surgery, three and six months after surgery will include the following parameters:

* surface area;
* Vancouver scar scale (VSS)
* vascularization and pigmentation;
* dermal architecture. After 3 and 6 months patients will undergo a biopsy of the scar under local anesthesia. The experimental group, treated with the SSD will undergo one extra biopsy of the formerly stretched skin.

Safety evaluation:

During the trial, adverse events are observed and evaluated. Adverse reactions to clinical manifestations are followed and recorded till the symptoms disappear. The subject with serious adverse events shall withdraw from the study and be treated accordingly.

• Skin stretching device (SSD) (Device): By making use of skin viscoelasticity, the special metal crochet of SSD would be embedded in both sides skin of the wound. Multiple cycles of stretching and relaxing wound lead to extended skin, changing the high tension incision into a low tension incision and facilitating the direct suture.
• Skin grafting (Procedure): the standard technique of skin grafting after wound preparation.

Primary outcomes

• the change of surface area of the scar [change from surgery at 6 months]: it is performed by tracing the area of the scar directly onto non-stretchable transparent sterile sheets. then digitized and analyzed by software.

Secondary outcomes

• Operation time [during surgery]: refers to the time required for the application of skin stretching device or skin grafting
• Wound site and wound healing time [from surgery to 6 months]: record the site of the operation, and the time from the beginning of surgery to the complete healing of the wound.
• Vancouver scar scale (VSS) [3 and 6 months after surgery]: evaluate the scar scale by VSS
• scar vascularization index [3 and 6 months after surgery]: use photometric analyzer to measure its erythema index, assessing its angiogenesis and vascularization
• scar pigmentation index [3 and 6 months after surgery]: use photometric analyzer to measure its melanin index, assessing its pigmentation
• collagen fibers arrangement under electron microscopy [surgery and 6 months after surgery]: use the drilling device to take the skin tissue of the diameter of 3mm for histological examination, measuring the collagen fibers arrangement by Electron microscopy
• dermal matrix arrangement under electron microscopy [surgery and 6 months after surgery]: use the drilling device to take the skin tissue of the diameter of 3mm for histological examination, measuring the dermal matrix arrangement by Electron microscopy

Sex: All, ages: 18 Years to any

Inclusion criteria:

1. Age≥18 years old
2. Tension incision that cannot be directly closed due to limb trauma or surgical debridement
3. Incision that cannot be directly closed after the incision decompression for fascia compartment syndrome and ischemia and reperfusion injury
4. Both sides of the incision skin suitable for skin stretching

Exclusion criteria:

1. Age <18 years old
2. Skin disease
3. Keloid history
4. Local or systemic use of hormones
5. Systemic diseases: for example, diabetes, immunodeficiency disease, vascular disease and etc.
6. Other poor general state to result in inability for trial;
7. Mental illness.

• Verhaegen PD, Bloemen MC, van der Wal MB, Vloemans AF, Tempelman FR, Beerthuizen GI, van Zuijlen PP. Skin stretching for primary closure of acute burn wounds. Burns. 2014 Dec;40(8):1727-37. doi: 10.1016/j.burns.2014.03.014. Epub 2014 Apr 16. PMID 24746282
• Verhaegen PDHM, van Trier AJM, Jongen SJM, Vlig M, Nieuwenhuis MK, Middelkoop E, van Zuijlen PPM. Efficacy of skin stretching for burn scar excision: a multicenter randomized controlled trial. Plast Reconstr Surg. 2011 May;127(5):1958-1966. doi: 10.1097/PRS.0b013e31820cf4be. PMID 21228739

• Xin Tang, Principal investigator, The First Affiliated Hospital of Dalian Medical University