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Madiedo et al. Plast Aesthet Res 2018;5:40 I http://dx.doi.org/10.20517/2347-9264.2018.40 Page 9 of 10

of small skin fragments. Conversely, placing grafts without considering their orientation usually involves
the cutting of skin segments that protrude from the wound, which results in the loss of multiple small skin
fragments.

Based on the results obtained in this study, we believe that tension forces acting on the grafted areas are
essential in scarring. Orientation seems to be a relevant factor for such forces to exert more or less tension on
the scar. Orienting grafts transversely, following Kraissl’s lines, lowers tension of these scarring forces, which
translates into more esthetic and functional characteristics. Further studies are required engaging a larger
population sample and having multicenter and controlled designs that will allow to determine and measure
the static and dynamic forces involved in the scarring of skin grafts.

In conclusion, burns are a type of trauma resulting in great morbidity rates. They compromise large portions of
the skin in each patient and require a multidisciplinary and multimodal management to improve functionality
and scar appearance. Abnormal scars are caused by several factors that affect scarring. One of the primary
factors involves the tension exerted on the wound. Considering these relaxed skin tension lines, when applying
split-thickness skin graft sheets transversely, reduces tension and minimizes the risk of developing abnormal
scars, thereby achieving better esthetic results.

DECLARATIONS
Authors’ contributions
Concept and design: Madiedo R
Data acquisition: Gaviria-Castellanos JL
Data analysis, manuscript preparation: Gaviria-Castellanos JL, Zapata-Ospina A
Critical revision and completion of manuscript: Madiedo R, Gaviria-Castellanos JL

Availability of data and materials
Data were strictly obtained from medical records, in accordance with the privacy policy and code of ethics
of our institute.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
This study was approved by the Hospital and all authors gave their consent to participate. Ethical approval
number UI-19-15.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology
worldwide: a systematic review. Burns 2017;43:249-57.