Inhibitory effects of local pretreated epidermis on wound scarring: A feasible method to minimize surgical scars

Objective: To inhibit surgical scarring by pretreating epidermis at the operation site. Methods: Eight patients who were to undergo operation through a modified incision incisions technique and other eight subjects presenting for skin grafting were recruited. For the modified incision patients a method to make the site ‘epidermis-free’ was developed. At the operating site a split thickness rectangular skin flap was raised with a width of one cm l transverse to the incision direction. Incision was then made through the exposed dermis. The flap was repositioned onto the incision site after intradermal suturing of the incision line following the subcutaneous operation. When skingrafting the graft was used in extended form by de-epithelialising the margins of the wound by 1 cm before graft placement. Then a skin graft with medial full-thickness and marginal split-thickness areas was transplanted onto the extended wound. In the control site-matched groups, surgical skin incision and skin grafting were performed as usual. Clinical observation and immunohistological examination were applied to evaluate the wound healing and scar formation in all subjects. Results: Both epidermis-free incision and extended skin graft sites showed perfect wound healing with short-term subjective scarring disturbance and slight wound scars, different from the control groups. The histological results showed the healing tissues in the experimental groups were more similar to normal dermis than those in the control groups. The immuoreactivities of type I and type II collagen in epidermis-free incision were both much lower than those in the control incision and the ratio of type I to type III collagen in the experimental incision was nearer to normal value. Conclusion: Pretreating local epidermis can effectively minimize postoperative scarring by modulating collagen synthesis.