Split-thickness skin grafts are commonly used for reconstruction of soft tissue defects with a well-vascularised wound bed. This study evaluated changes in scar elasticity, pliability, erythema and pigmentation during scar maturation and compared scars on deep dermal versus muscular wound beds. Seventeen graft scars on deep dermal wound beds and five on muscular wound beds were assessed at 1, 3, 6 and 12 months postoperatively using the Vancouver, Hamilton and Manchester scar scales, as well as a visual analog scale. Objective measurements included skin elasticity and pliability (Cutometer) and erythema and melanin content (Mexameter). All scar scale scores improved significantly over 12 months. Skin pliability increased continuously and remained higher in deep dermal wound beds than in muscular wound beds. Skin elasticity was initially slightly increased compared to healthy skin. The erythema index decreased over time, while the melanin index increased, both approaching control values. Melanin levels were consistently higher in deep dermal wound beds and increased more rapidly at scar margins. Overall, split-thickness skin graft scars showed prolonged maturation, with only elasticity and melanin content reaching healthy skin levels within 12 months. Preservation of the deep dermis, when possible, may improve scar quality.
Illg et al. (Fri,) studied this question.