105 Scar Quality of Skin Graft Borders: A Prospective Randomized Double Blinded Evaluation
Bibliographic record
Abstract
Prominent scars may remain around the border of a mature skin graft (SG) at the interface of the SG and normal skin. The border of a SG may be constructed by either exactly approximating (A), or slightly overlapping (O) the edge of the SG on the wound margin. The purpose of this study was to evaluate whether A or O affects the quality of the border scar of SGs applied to burn patients. This prospective study was a within-border design in which adult burn patients requiring SGs served as their own control. Half of each study border was fashioned using O and the immediately adjacent other half was made using A. We randomly assigned O or A to the proximal or distal halves of vertical borders and the medial and lateral halves of horizontal borders. Both halves of the study border were identically fixated with staples or sutures, and were managed in the same fashion postoperatively. Evaluations at 3, 6, and 12 months of O and A borders were performed by a blinded OT using the Vancouver Scar Scale (VSS), The Observer Scar Assessment Scale (OSAS), and a global binary assessment of which half of the study border “looked better”. Patients were also blinded and rated each half of the study border with a visual analogue scale (VAS). Values are reported as the mean ± SD or median (IQR), as appropriate. There were 34 borders studied in 15 subjects [46.7% female, age 29 (22,57), % TBSA burn 9.7 ± 5.3, and no inhalation injuries]. Study borders were constructed at 7 (5,11) days post burn, had a total length of 12 (9.3, 14.5) cm, and all involved split thickness SGs of thickness 13 (12, 14)/ 1000th inches. Sheet grafts were applied in 27% and meshed grafts in 73%. SGs were applied immediately after excision in 75% or after allografting in 25%. Border scars matured between 3 and 12 months with reductions in total VSS from 8 (7,8) to 4 (3,6) for O borders (p< 0.001) and from 8 (7,9) to 4 (1,6) for A borders (p<0.001). However, there were no significant differences between O and A borders in total VSS at 3 months (p=0.165), 6 months (p= 0.602) and 12 months (p=0.358), or in total OSAS at 3 months (p=0.681), 6 months (p=0.890), or 12 months (p=0.601). At 12 months, 60% of O borders and 40% of A borders were globally rated as “better” (p = 0.258). There were no significant differences in the patients’ subjective ratings of the O and A borders at 3 months (p=0.914), 6 months (p=0.955), and 12 months (p=0.665). The quality of the scar at the border of a skin graft does not appear to be affected by the surgical technique used to construct the border at the time of grafting Borders around skin grafts can be constructed either with an overlapping method or an approximating method. Both techniques appear to produce similar border scars.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".