ScarringNCT05758181
Undermining Apices in Surgical Wounds
A study testing Apical Undermining in people with Scarring, run by University of California, Davis at 1 site in United States.
Trial summary
When patients have surgery on the neck, trunk, arms, or legs, stitches are the standard way to close the wound. Wounds always result in a scar, but doctors are always looking for ways to reduce scarring. Several studies have been done to test ways to close wounds that reduce scarring. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Scarring
- What is being tested?
- Apical Undermining
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 siteUnited States
- Study dates
- 9 Aug 2023to 31 Mar 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 18 years of age or older
- Able to give informed consent themselves
- Patient scheduled for cutaneous surgical procedure on the neck, trunk, and extremities with predicted primary closure
- Willing to return for follow-up visit
Who cannot join
- Incarceration
- Under 18 years of age
- Pregnant women
- Unable to understand written and oral English
- Wounds with predicted closure length less than 3cm
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site
University of California, Davis - Dermatology Department
Sacramento, California, 95816
About this study
Official title: Undermining Apices in Surgical Wounds: a Randomized Evaluator-blinded Split-wound Comparative Effectiveness Trial
When patients have surgery on the neck, trunk, arms, or legs, stitches are the standard way to close the wound. Wounds always result in a scar, but doctors are always looking for ways to reduce scarring. Several studies have been done to test ways to close wounds that reduce scarring. One idea is to reduce the tension around the cut. One way to reduce tension is to free up the skin around the wound. This procedure is also called "undermining". Some studies have shown that freeing up the skin near the tips of the wound, called the "apices," is helpful for improving the cosmetic outcome of scars. This study will investigate if there are any differences in the appearances of the scar if one tip is undermined and the other is not.
Read the detailed description
Reducing scar tissue formation and postoperative complications in wound closure has remained the focus of recent studies and decreases the cost and time burden of follow-up visits and procedures. Such studies have highlighted the impact of mechanical forces and tension on scar formation, demonstrating that reducing the mechanical stress within the wound environment results in better aesthetic outcomes. Undermining peripheral and apices of the wound has been used in the closure of large and tight defects allowing the closure of these wounds by reducing the tension. Undermining has been shown to reduce tension, and peripheral and apical undermining has been recommended for decreasing scar formation. However, extensive undermining may increase the complications of the surgery by reducing vascularization and creating a space for hematomas. To our knowledge, the impact of scar cosmesis and the rate of postoperative complications in apical undermining in the linear repair of surgical wounds have not been studied, and it remains unknown whether undermining the apices can decrease the protrusion of the scar tissue at the edges. This study seeks to determine the effectiveness of apical undermining of linear wound closures in improving scar cosmesis by using individuals as their own controls in a split-scar model.
This is a single center, randomized, evaluator-blinded, split wound study.
After screening and informed consent, demographic data will be collected including age, race, gender, and medical record number. This will be collected within the Redcap database.
The patient's wound will be labeled A if it is on the left or superior side of the investigator and B if it is on the right or inferior side. A concealed randomization result will be obtained from the Redcap randomization module, which will specify which side, A or B, will receive apical undermining
Following this, both sides of the wound will be sutured together with a subcutaneous (bottom) layer of stitches. Next, a cutaneous layer of sutures will be placed, as is the standard of care. A digital image of the wound after the epidermal closure will be obtained; these may be used in scientific talks and/or for publication purposes. The patient will then be instructed to continue dressing changes along the entire length of the surgical site until the wound is fully healed as is the standard of care.
Treatment assignment, wound length, demographic data, and digital images will be recorded within the Redcap database. Follow-up assessment will be scheduled for three months following the procedure, with a one-month window before or after that time if the patient cannot return at precisely three months.
- Conditions
- Scarring
- Being tested
- Apical Undermining
- Medical subject headings
- Cicatrix
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Apical UnderminingOther
The skin at the tip of the wound will be freed to reduce tension.
| Study group | Role | What they receive |
|---|---|---|
| Linear Wound Closure | No intervention | A cutaneous layer of sutures will be placed on one side, as is standard of care. |
| Linear Wound Closure with Apical Undermining | Experimental | The other side of the wound will have a cutaneous layer of sutures, as is standard of care, and will receive apical undermining. Receives: Other: Apical Undermining |
What is being measured
The primary outcome is the main question the study is designed to answer.
Observer Scar Assessment as measured by Patient Observer Scar Assessment Score (POSAS)
The primary endpoint will be the score of two blinded reviewers independently using the POSAS assessment. The observer scale of the POSAS consists of six items (vascularity, pigmentation, thickness, relief, pliability, and surface area). All items are scored on a scale ranging from 1 ("like normal skin") to 10 ("worst scar imaginable"). The sum of the six items results in a total score of the POSAS observer scale. Furthermore, an overall opinion is scored on a scale ranging from 1 to 10. All parameters should preferably be compared to normal skin on a comparable anatomic location.
Measured: 3 months
Secondary outcomes (3)
Patient Scar Assessment as measured by Patient Observer Scar Assessment Score (POSAS)
This is the patient portion of the POSAS assessment, which will be independently recorded. The patient scale of the POSAS consists of six items (pain, itch, thickness, color, stiffness, and irregularity). All items are scored on a scale ranging from 1 ("as normal skin") to 10 ("yes, very different"). The sum of the six items results in a total score of the POSAS patient scale. Furthermore, an overall opinion is scored on a scale ranging from 1 to 10.
Measured: 3 months
Width of Scar as measured using Trace-to-Tape Method
The trace-to-tape method is an objective measure for linear postoperative scars. The mean scar width will be determined using the trace-to-tape method. The surface area of the scar will be collected by tracing the scar with a water-based gel pen. While still wet, the gel residue will be lifted from the skin with clear packing tape and transferred on a sheet of paper.
Measured: 3 months
Complications or Adverse Events from Treatment
For example, if one half of the scar has more associated erythema, as measured using the Trace-to-Tape method, then it will be recorded. Other complications from the treatment will also be recorded.
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Mar 2023
- Study start9 Aug 2023
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for ScarringStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 50 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of California, Davis
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Daniel Eisen, MD, Principal investigator, University of California, Davis - Dermatology
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05758181
- Sponsor's protocol ID
- 1999193
- Status last verified
- Feb 2026
- First submitted
- 24 Feb 2023
- Last updated
- 10 Feb 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Gurtner GC, Dauskardt RH, Wong VW, Bhatt KA, Wu K, Vial IN, Padois K, Korman JM, Longaker MT. Improving cutaneous scar formation by controlling the mechanical environment: large animal and phase I studies. Ann Surg. 2011 Aug;254(2):217-25. doi: 10.1097/SLA.0b013e318220b159.
PubMed 21606834Barnes LA, Marshall CD, Leavitt T, Hu MS, Moore AL, Gonzalez JG, Longaker MT, Gurtner GC. Mechanical Forces in Cutaneous Wound Healing: Emerging Therapies to Minimize Scar Formation. Adv Wound Care (New Rochelle). 2018 Feb 1;7(2):47-56. doi: 10.1089/wound.2016.0709.
PubMed 29392093Krishnan NM, Brown BJ, Davison SP, Mauskar N, Mino M, Jordan MH, Shupp JW. Reducing Wound Tension with Undermining or Imbrication-Do They Work? Plast Reconstr Surg Glob Open. 2016 Jul 13;4(7):e799. doi: 10.1097/GOX.0000000000000799. eCollection 2016 Jul.
PubMed 27536478Zitelli JA. TIPS for a better ellipse. J Am Acad Dermatol. 1990 Jan;22(1):101-3. doi: 10.1016/0190-9622(90)70016-b.
PubMed 2405023Jonathan K (Ed). Dermatologic Surgery. McGraw-Hill Education. 2018. ISBN: 978-1-25-964392-7.
Study at a glance
From the registry record, last updated by the sponsor on 10 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Undermining Apices in Surgical Wounds: a Randomized Evaluator-blinded Split-wound Comparative Effectiveness Trial
- ClinicalTrials.gov ID
- NCT05758181
- Acronym / sponsor ID
- 1999193
- Conditions
- Scarring
- Study type
- Interventional
- Recruitment status
- Enrolling by invitation
- Enrolment
- 50 participants (estimated)
- Lead sponsor
- University of California, DavisUniversity, hospital or other
- Study start
- 9 Aug 2023 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Mar 2027 (estimated)
- First posted
- 7 Mar 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
When patients have surgery on the neck, trunk, arms, or legs, stitches are the standard way to close the wound. Wounds always result in a scar, but doctors are always looking for ways to reduce scarring. Several studies have been done to test ways to close wounds that reduce scarring. One idea is to reduce the tension around the cut. One way to reduce tension is to free up the skin around the wound. This procedure is also called "undermining". Some studies have shown that freeing up the skin near the tips of the wound, called the "apices," is helpful for improving the cosmetic outcome of scars. This study will investigate if there are any differences in the appearances of the scar if one tip is undermined and the other is not.
Detailed description
Reducing scar tissue formation and postoperative complications in wound closure has remained the focus of recent studies and decreases the cost and time burden of follow-up visits and procedures. Such studies have highlighted the impact of mechanical forces and tension on scar formation, demonstrating that reducing the mechanical stress within the wound environment results in better aesthetic outcomes. Undermining peripheral and apices of the wound has been used in the closure of large and tight defects allowing the closure of these wounds by reducing the tension. Undermining has been shown to reduce tension, and peripheral and apical undermining has been recommended for decreasing scar formation. However, extensive undermining may increase the complications of the surgery by reducing vascularization and creating a space for hematomas. To our knowledge, the impact of scar cosmesis and the rate of postoperative complications in apical undermining in the linear repair of surgical wounds have not been studied, and it remains unknown whether undermining the apices can decrease the protrusion of the scar tissue at the edges. This study seeks to determine the effectiveness of apical undermining of linear wound closures in improving scar cosmesis by using individuals as their own controls in a split-scar model.
This is a single center, randomized, evaluator-blinded, split wound study.
After screening and informed consent, demographic data will be collected including age, race, gender, and medical record number. This will be collected within the Redcap database.
The patient's wound will be labeled A if it is on the left or superior side of the investigator and B if it is on the right or inferior side. A concealed randomization result will be obtained from the Redcap randomization module, which will specify which side, A or B, will receive apical undermining
Following this, both sides of the wound will be sutured together with a subcutaneous (bottom) layer of stitches. Next, a cutaneous layer of sutures will be placed, as is the standard of care. A digital image of the wound after the epidermal closure will be obtained; these may be used in scientific talks and/or for publication purposes. The patient will then be instructed to continue dressing changes along the entire length of the surgical site until the wound is fully healed as is the standard of care.
Treatment assignment, wound length, demographic data, and digital images will be recorded within the Redcap database. Follow-up assessment will be scheduled for three months following the procedure, with a one-month window before or after that time if the patient cannot return at precisely three months.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Linear Wound Closure | No intervention | –A cutaneous layer of sutures will be placed on one side, as is standard of care. |
| Linear Wound Closure with Apical Undermining | Experimental | Other: Apical UnderminingThe other side of the wound will have a cutaneous layer of sutures, as is standard of care, and will receive apical undermining. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- 18 years of age or older
- Able to give informed consent themselves
- Patient scheduled for cutaneous surgical procedure on the neck, trunk, and extremities with predicted primary closure
- Willing to return for follow-up visit
Key exclusion criteria (5 listed)
- Incarceration
- Under 18 years of age
- Pregnant women
- Unable to understand written and oral English
- Wounds with predicted closure length less than 3cm
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Apical UnderminingThe skin at the tip of the wound will be freed to reduce tension. | Other | Linear Wound Closure with Apical Undermining |
Primary outcome
Observer Scar Assessment as measured by Patient Observer Scar Assessment Score (POSAS)
Time frame: 3 months
The primary endpoint will be the score of two blinded reviewers independently using the POSAS assessment. The observer scale of the POSAS consists of six items (vascularity, pigmentation, thickness, relief, pliability, and surface area). All items are scored on a scale ranging from 1 ("like normal skin") to 10 ("worst scar imaginable"). The sum of the six items results in a total score of the POSAS observer scale. Furthermore, an overall opinion is scored on a scale ranging from 1 to 10. All parameters should preferably be compared to normal skin on a comparable anatomic location.
3 secondary outcomes
Patient Scar Assessment as measured by Patient Observer Scar Assessment Score (POSAS)
Time frame: 3 months
Width of Scar as measured using Trace-to-Tape Method
Time frame: 3 months
Complications or Adverse Events from Treatment
Time frame: 3 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Feb 2026.
- Background: PubMed 21606834Gurtner GC, Dauskardt RH, Wong VW, Bhatt KA, Wu K, Vial IN, Padois K, Korman JM, Longaker MT. Improving cutaneous scar formation by controlling the mechanical environment: large animal and phase I studies. Ann Surg. 2011 Aug;254(2):217-25. doi: 10.1097/SLA.0b013e318220b159.
- Background: PubMed 29392093Barnes LA, Marshall CD, Leavitt T, Hu MS, Moore AL, Gonzalez JG, Longaker MT, Gurtner GC. Mechanical Forces in Cutaneous Wound Healing: Emerging Therapies to Minimize Scar Formation. Adv Wound Care (New Rochelle). 2018 Feb 1;7(2):47-56. doi: 10.1089/wound.2016.0709.
- Background: PubMed 27536478Krishnan NM, Brown BJ, Davison SP, Mauskar N, Mino M, Jordan MH, Shupp JW. Reducing Wound Tension with Undermining or Imbrication-Do They Work? Plast Reconstr Surg Glob Open. 2016 Jul 13;4(7):e799. doi: 10.1097/GOX.0000000000000799. eCollection 2016 Jul.
- Background: PubMed 2405023Zitelli JA. TIPS for a better ellipse. J Am Acad Dermatol. 1990 Jan;22(1):101-3. doi: 10.1016/0190-9622(90)70016-b.
- BackgroundJonathan K (Ed). Dermatologic Surgery. McGraw-Hill Education. 2018. ISBN: 978-1-25-964392-7.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Daniel Eisen, MD principal investigator
University of California, Davis - Dermatology
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Apical Undermining in people with Scarring, run by University of California, Davis at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: enrolling by invitation, as of the sponsor's last update on 10 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Observer Scar Assessment as measured by Patient Observer Scar Assessment Score (POSAS) (time frame: 3 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05758181, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Feb 2026.