Paper Tape May Improve Scar Aesthetics and Prevent Wound Closure Complications

Abstract

There is uncertainty whether postoperative application of paper tape (PT) improves scar aesthetics and reduces wound closure complications. This study aimed to review and assess the quality of applicable findings from studies investigating PT’s efficacy. We queried PubMed and SCOPUS using the search terms “((“paper tape”) AND (wound OR closure OR heal* OR complication OR skin OR prevent* OR scar*)).” We excluded articles that were duplicates, basic science, or not clinically relevant. We assessed the level of evidence for each article using the American Society of Plastic Surgeons (ASPS) Rating Levels of Evidence and Grading Recommendations for Therapeutic Studies, ranging from I (highest) to V (lowest). Of 186 publications reviewed, we included eight studies in the literature review. Five of these studies reported statistically significant positive outcomes on scar aesthetics and wound closure associated with using PT. Using the ASPS rating system, we found that two studies were Level I, three studies were Level II, two studies were Level IV, and one study was Level V. Notably, heterogeneity in the study designs limited outcome comparison. The data from the studies included in this literature review support using PT to optimize scar and wound management. The lack of higher levels of evidence, however, suggests the need for additional randomized controlled trials to rigorously evaluate patient outcomes when using PT compared with other forms of adhesive dressings.

With the quantity and variety of surgical skin incisions and traumatic lacerations, physicians worldwide are constantly seeking efficient, easy, and affordable techniques to hasten wound healing and optimize long-term scar aesthetics without compromising outcomes (Bekara et al., 2018). Trauma, whether surgical or accidental, subjects the skin to tension and mechanical stretching forces that may promote aberrant dermal fibroproliferation, culminating in suboptimal scarring. This, in turn, may result in scar revisions and overutilization of medical resources (Hicks et al., 2019). Therefore, preventing abnormal scarring by minimizing tension on the wound and initiating early closure is key in the healing process (Ogawa et al., 2021).

Presently, the most common interventions for wound closure include absorbable or nonabsorbable sutures, staples, tissue glues, and adhesive tape (Al-Mubarak & Al-Haddab, 2013; Jafari et al., 2021; Singer et al., 1997). Using adhesive tape as an alternative to sutures was first identified by Gillman et al. (1955) and since then, adhesive tape has been extensively studied for its wound closure capabilities (Coulthard et al., 2004, 2010; Dumville et al., 2014; Gkegkes et al., 2012; Kolt, 2003). Atraumatic, suture-less adhesive tape facilitates wound healing by securing the wound from the hostile external environment, reducing tension on the wound, and minimizing the risk of bacterial inoculation of the wound (Katz et al., 1999; Kolt, 2003). Currently, there are multiple types of commercially available medical adhesive tapes that are made of paper, plastic, silicone, or cloth (Zeng et al., 2016). The paper-based form is hypoallergenic and porous; it is commonly used as a lightweight dressing and to secure intravenous lines and noncritical tubes.

Although anecdotal findings suggest that paper tape (PT) offers benefits that include comfort, gentleness, infection prevention, faster wound closure, and less noticeable scar appearances to postoperative patients during periods of short-term wound closure and long-term scar management, there remains uncertainty in the published literature. Therefore, the purpose of this review is to appraise and assess the quality of data in relevant articles regarding the efficacy of PT in optimizing scar aesthetics and reducing wound closure complications.

METHODS

In August 2022, we searched the PubMed and SCOPUS databases using the search terms “((“paper tape”) AND (wound OR closure OR heal* OR complication OR skin OR prevent* OR scar*)).” Inclusion criteria were articles that examined outcomes related to wound closure or scar management in men and/or women, 18 years and older, who underwent surgical procedures that may result in hypertrophic or keloid scarring. Exclusion criteria were duplicate articles, review articles, articles that could not be accessed in full, articles not clinically relevant, articles published before 1990, and basic science articles.

Based on how each study applied the PT, we divided the included studies into two categories: wound closure and scar management. In the wound closure category, the PT was applied immediately after surgical wound closure for a short duration of time for the purpose of securing the wound. In the scar management category, the PT was applied after complete wound closure for a prolonged duration of time for the purpose of scar aesthetics.

We extracted the following data from each article: country, study type, number of participants, PT application, duration of PT application, variables assessed, including scale used to evaluate wound closure and/or scar appearance, postoperative time of assessment, and outcomes obtained. As shown in Table 1, we used the American Society of Plastic Surgeons (ASPS) Rating Levels of Evidence and Grading Recommendations for Therapeutic Studies to evaluate the studies included in our review, an evidence-based scale that classifies therapeutic studies according to their study design and strength and assesses the level of evidence using a scale ranging from I (highest quality) to V (lowest quality) (Swanson et al., 2010). C.S. and S.H. screened the articles and O.O. independently cross-checked them.

TABLE 1.

American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations for Therapeutic Studies

Level of evidence	Qualifying studies	Number of studies
I	High-quality, multicenter or single center, randomized controlled trial with adequate power; or systematic review of these studies	2
II	Lesser quality, randomized controlled trial; prospective cohort or comparative study; or systematic review of these studies	3
III	Retrospective cohort or comparative study; case–control study; or systematic review of these studies	0
IV	Case series with pre/posttest; or only posttest	2
V	Expert opinion developed via consensus process; case report or clinical example; or evidence based on physiology, bench research or “first principles”	1

Note. From “How to Practice Evidence-Based Medicine,” by J. A. Swanson, D. Schmitz, and K. C. Chung, 2010, Plastic and Reconstructive Surgery, 126(1), pp. 286–294 (https://doi.org/10.1097/PRS.0b013e3181dc54ee). Copyright 2010 by the American Society of Plastic Surgeons. Adapted with permission from Wolters Kluwer Health, Inc.

RESULTS

As shown in Figure 1, our literature searches yielded 186 publications for initial review (64 in PubMed and 122 in SCOPUS). After compiling the articles from each search and removing duplicates, we screened the abstracts of 133 articles. We excluded 110 articles because the abstracts were not relevant to postoperative PT application or because the articles were classified as systematic reviews. We reviewed the full text of the remaining 23 articles and removed 15 because they met our exclusion criteria. Ultimately, we included eight articles in this review. The pertinent study characteristics and outcomes of these articles are synthesized in Table 2. We classified the three studies by Chao and Tsaez (1990), Chen et al. (2001), and Luckraz et al. (2007) as wound closure studies and the five studies by Atkinson et al. (2005), Ishii et al. (2021), Lin et al. (2020), Reiffel (1995), and Sugamata et al. (2012) as scar management studies.

FIGURE 1.

Flow diagram of literature search results. From “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” by M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, R. Chou, J. Glanville, J. M. Grimshaw, A. Hróbjartsson, M. M. Lalu, T. Li, E. W. Loder, E. Mayo-Wilson, S. McDonald, … D. Moher, 2021, BMJ, 372, p. 71 (https://doi.org/10.1136/bmj.n71). Copyright 2021 by BMJ Publishing Group Ltd.

TABLE 2.

Synthesis of Studies and Study Characteristics of Articles Meeting the Inclusion Criteria

Reference	Country	Type of study	Number of participants	PT application	Duration of PT application	Variables assessed	Postoperative time of assessment	Outcomes
Chao & Tsaez, 1990	Taiwan	Expert opinion	N = 42 total All PT	Wound closure following surgery for gynecological malignant or benign disease Micropore hypoallergenic PT	PT applied for 7–10 days immediately after closure on top of nonabsorbable silk sutures for muscle sheath closure In case of wound infection, treatment applied and then secondary wound closure performed with PT	No scale applied Wound infections Cosmetic appearance Subcutaneous hematoma Skin separation Skin itching Allergic reactions Wound discomfort/tightness	Prior to hospital discharge	All wounds cosmetically satisfactory No subcutaneous hematoma, skin separation, skin itching, allergic reactions, or discomfort/tightness around wounds Three wound infections following wound contamination (traumatic duodenal perforation, n = 1; perforated duodenal ulcers, n = 2)
Chen et al., 2001	Taiwan	Prospective, nonrandomized controlled study	N = 300 total  PT (n = 150)  IS (n = 150)	Wound closure following elective colorectal resection Compared micropore hypoallergenic PT with IS	Fascial layer approximation performed with a continuous polydioxanone monofilament for all wounds beneath PT or IS PT applied for 7–10 days immediately after closure IS removed at 7 days postoperatively	Nonstandardized scale applied Skin closure time Pain on removal Wound complications Scar narrowest width Scar widest width Scar satisfaction	Immediately after closure and daily for the duration of PT or IS application and at 6 months	Faster skin closure in the PT group than in the IS group (p < .01) Less pain on removal of wound closure technique in the PT group than in the IS group (p < .01) Higher scar satisfaction in the PT group than in the IS group (p = .03) No statistically significant differences in wound complication rates, narrowest width, or widest width of scar formation between groups
Luckraz et al., 2007	United Kingdom	Prospective randomized double-blind controlled trial	N = 60 total  PT (n = 30)  Sutures (n = 30)	Wound closure in patients undergoing VATS in lung surgery Compared PT wound closure strips with Monocryl absorbable sutures	PT applied immediately after port removal Exact duration of PT application unclear	ASEPSIS score to assess: Additional treatment Serous discharge Erythema Purulent exudates Separation of deep tissues Isolation of bacteria Stay as inpatient prolonged over 14 days VAS to assess: Discomfort/pain Clinically significant pneumothorax Wound closure duration Cost savings	Prior to hospital discharge and at 6 weeks	No pneumothoraxes, wound dehiscence, or infection in either group No significant differences in immediate postoperative pain scores, wound cosmesis, and wound complications between groups Wound closure 7.1 s/mm faster in the PT group than in the sutures group (p < .001) Wound closure cost $3.20 less per patient in the PT group than in the sutures group (p < .01)
Atkinson et al., 2005	Australia	Randomized controlled trial	N =70 total  PT (n = 34)  Control (n = 36)	Scar management following cesarean delivery Compared micropore hypoallergenic PT with no intervention (control)	PT applied 4–6 days postoperatively following suture/staple removal or wound closure and continued for 12 weeks	International Clinical Recommendations 10-point scale to assess: Itch Pain Scar volume Scar tension Wound tensile strength Hydration Application time Cost Linear surgical incision size Postoperative complications Treatment compliance	6 weeks, 12 weeks, and 6 months	Scar volume 0.16 cm3 lower in the PT group than in the control group (95% CI [0.00, 0.29]) 0% hypertrophic scarring in the PT group vs. 41% in the control group at 12 weeks postoperatively (exact test, p = .003) Odds of hypertrophic scarring 13.6 times greater in the control group than in the PT group (95% CI [3.6, 66.9])
Ishii et al., 2021	Japan	Prospective cohort study	N = 163 total Nonwoven surgical tape: TE only (n = 58) SBI (n = 34) Polyesterwoven fabric tape: TE only (n = 30) SBI (n = 41)	Scar management following breast reconstruction Compared nonwoven surgical tape with polyester-woven fabric tape	PT applied the day after suture removal and continued for 4 months	VSS to assess: Scar width Scar score Skin complications Aesthetic result Contact dermatitis Pigmentation	5 months	Scar width between groups: TE only (p = .30) SBI (p = .40) Scar score higher in the polyester-woven fabric group than in the nonwoven surgical tape group: TE only (p < .05) SBI (p < .05) Less contact dermatitis and pigmentation in the polyester-woven fabric group than in the nonwoven surgical tape group: TE only (p < .05) SBI (p < .05)
Lin et al., 2020	Taiwan	Randomized comparative study	N = 47 total Each wound divided in half:  23 with PT right/SS left  24 with SS right/PT left	Scar management following cesarean delivery Compared PT wound closure strips with SS	PT applied 1 week postoperatively and continued for 3 months	VSS to assess: Pliability Height Vascularity Pigmentation VAS to assess: Itch Pain Scar appearance	1, 3, 6, and 12 months	No significant VSS score differences between groups Better VAS scores for scar appearance in the SS group than in the PT group at follow-up: 6 months (p = .03) 12 months (p = .04) No significant differences in itch or pain between groups
Reiffel, 1995	United States	Case series	N = 64 total All PT	Scar management following various operations or scar revision surgery Type of PT not specified	PT applied 2 weeks postoperatively following suture removal and continued for 2 months or more until scar matured (Case 1 for 6 months continuously and then 3 months intermittently; Case 2 for 2.5 months; Case 3 for 2 months)	No scale applied Scar appearance Scar satisfaction	Multiple time points, with photographs included at 2 months, 1 year, and 2.5 years for Cases 1, 2, and 3, respectively	PT application effective in “most” patients at achieving a “thin, soft” scar, as opposed to a hypertrophic one “Most” patients completely satisfied with results
Sugamata et al., 2012	Japan	Case series	N = 4 total  PT only (n = 1)  PT with SI (n = 3)	Scar management following primary keloid resection in the pubic area using extremely everted wound suture with deep dermal stitches and multiple Z-plasty Mesh PT bandage Concurrent regional SI	PT applied 10 days postoperatively following suture removal and continued for 2–4 years until scar matured	No scale applied Keloid recurrence Scar widening	2 years for Cases 1 and 2; 4 years for Cases 3 and 4	None showed keloid recurrence Scar widening after 4 years, 3–6 mm widths, in two SI patients with PT No concerns over scar widening

Note. ASEPSIS = Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay as inpatient prolonged over 14 days; IS = interrupted silk sutures; PT = paper tape; SBI = silicone breast implant; SI = steroid injections; SS = silicone sheets; TE = tissue expander; VAS = visual analog scale; VATS = video-assisted thoracoscopic surgery; VSS = Vancouver Scar Scale.

The majority of the studies were conducted in Asia, with three studies occurring in Taiwan (Chao & Tsaez 1990; Chen et al., 2001; Lin et al., 2020) and two studies occurring in Japan (Ishii et al., 2021; Sugamata et al., 2012). The remaining three studies were conducted in Australia (Atkinson et al., 2005), the United Kingdom (Luckraz et al., 2007), and the United States (Reiffel, 1995).

PT Application

PT was most often applied in the setting of cesarean delivery procedures (Atkinson et al., 2005; Lin et al., 2020; n = 2), followed by breast reconstruction (Ishii et al., 2021; n = 1), keloid resection (Sugamata et al., 2012; n = 1), lung surgery (Luckraz et al., 2007; n = 1), colorectal resection (Chen et al., 2001; n = 1), abdominal wound closure (Chao & Tsaez, 1990; n = 1), and operation/scar revision (Reiffel, 1995; n = 1;). The most common type of PT applied was 3M Micropore surgical tape (3M, St. Paul, MN; Atkinson et al., 2005; Chao & Tsaez, 1990; Chen et al., 2001; n = 3), followed by Steri-Strip reinforced adhesive skin closures (3M; Lin et al., 2020; Luckraz et al., 2007; n = 2). One study (Ishii et al., 2021) compared nonwoven surgical tape (Yu-ki Ban; Nitto Denko, Osaka, Japan) with hypoallergenic polyester-woven fabric tape (Atofine; Nichiban Co, Ltd., Tokyo, Japan). The remaining two studies either applied a meshed PT bandage (Sugamata et al., 2012) or did not specify the type of PT applied (Reiffel, 1995).

Duration of PT Application

Relative to the duration of PT application in the wound closure studies, Chao and Tsaez (1990) and Chen et al. (2001) applied PT for 7–10 days immediately after surgical wound closure. Luckraz et al. (2007) did not specify how long the PT was applied.

Relative to the duration of PT application in the scar management studies, Atkinson et al. (2005) applied PT for 12 weeks, Lin et al. (2020) applied PT for 3 months, Ishii et al. (2021) applied PT for 4 months, Reiffel (1995) reported the application of PT for 6 months continuously and then 3 months, 2.5 months, and 2 months intermittently (for Cases 1, 2, and 3, respectively), and Sugamata et al. (2012) reported the duration of PT application as “2–4 years” (p. 360).

Variables Assessed

The researchers used a variety of methods to rate scar and wound healing outcomes. To assess scar outcomes, Ishii et al. (2021) and Lin et al. (2020) used the Vancouver Scar Scale (VSS; n = 2); Lin et al. (2020) and Luckraz et al. (2007) used a visual analog scale (VAS; n = 2); Atkinson et al. (2005) used the International Clinical Recommendations (n = 1); Luckraz et al. (2007) used the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay as inpatient prolonged over 14 days (ASEPSIS) score (n = 1); and Chen et al. (2001) used a nonstandardized scale (n = 1). Chao and Tsaez (1990), Reiffel (1995), and Sugamata et al. (2012) did not apply any scale at all.

The wound closure studies (Chao & Tsaez, 1990; Chen et al., 2001; Luckraz et al., 2007; n = 3) assessed some version of the following variables: wound infections/complications, pain/discomfort, and skin/wound closure time. The scar management studies (Atkinson et al., 2005; Ishii et al., 2021; Lin et al., 2020; Reiffel, 1995; Sugamata et al., 2012; n = 5) assessed scar appearance, scar satisfaction, scar width/widening, scar volume, itch, and pigmentation. Atkinson et al. (2005) and Luckraz et al. (2007) assessed cost (n = 2).

Postoperative Assessment

The researchers of the wound closure studies assessed the wounds during the immediate postoperative period as follows: Chao and Tsaez (1990) and Luckraz et al. (2007) assessed the wound at unspecified times prior to hospital discharge; Chen et al. (2001) assessed the wounds every day for 7–10 days following wound closure; Luckraz et al. (2007) assessed the wounds a second time 6 weeks postoperatively; and Chen et al. (2001) assessed the wounds a second time 6 months postoperatively.

The researchers of the scar management studies assessed the wounds at various points after they had healed as follows: Atkinson et al. (2005) and Reiffel (1995) assessed variables at three consecutive time points (6 weeks, 12 weeks, and 6 months; 2 months, 1 year, and 2.5 years, respectively), enabling tracking and comparison of scar management techniques over the course of scar maturation; Ishii et al. (2021) assessed variables at 5 months only; Lin et al. (2020) assessed the wounds at 1, 3, 6, and 12 months; and Sugamata et al. (2012) assessed the wounds of two patients at 2 years and the wounds of 2 patients at 4 years.

Outcomes

The researchers of five studies (Atkinson et al., 2005; Chen et al., 2001; Ishii et al., 2021; Lin et al., 2020; Luckraz et al., 2007) reported statistically significant positive outcomes on scar aesthetics and wound closure when using PT. Atkinson et al. (2005; n = 70) found 0% hypertrophic scarring in the PT group compared with 41% hypertrophic scarring in the control group. Chen et al. (2001; n = 300) and Luckraz et al. (2007; n = 60) reported reduced skin closure time when using PT compared with sutures. Ishii et al. (2021; n = 163) found superior aesthetic outcomes when using woven PT compared with surgical tape. Lin et al. (2020; n = 47) found that silicone sheets produced a better, but not clinically meaningful, scar appearance compared with PT. Chao and Tsaez (1990; n = 42), Reiffel (1995; n = 64), and Sugamata et al. (2012; n = 4) reported cosmetically satisfactory scarring after PT application.

As shown in Figure 2, using the ASPS rating system, we found that Atkinson et al. (2005) and Luckraz et al. (2007) were Level I (high quality) whereas Chen et al. (2001), Ishii et al. (2021), and Lin et al. (2020) were Level II (lesser quality). These researchers found statistically significant results supporting the use of PT.

FIGURE 2.

Selected studies according to American Society of Plastic Surgeons rating.

Reiffel (1995) and Sugamata et al. (2012) were Level IV (case series), and Chao and Tsaez (1990) was Level V (expert opinion). These researchers used descriptive terms to report their findings on the cosmetic appearance and dimensions of scars across a postoperative time period, wound healing, and patient satisfaction.

DISCUSSION

The results of this review provide support for using PT for surgical wound closure. To facilitate wound closure, Chao and Tsaez (1990), Chen et al. (2001), and Luckraz et al. (2007) applied PT directly to the wound immediately after surgery for a short duration of time. Chao and Tsaez (1990) and Chen et al. (2001) showed that applying PT for 7–10 days postoperatively allowed ample time for the skin edges to adhere to one another and achieve wound closure. Chao and Tsaez (1990) found all wounds were cosmetically satisfactory, with no instances of skin separation prior to hospital discharge. Similarly, Luckraz et al. (2007) found no wound dehiscence both prior to hospital discharge and 6 weeks later, indicating sustained skin adherence. In all three wound closure studies (Chao & Tsaez, 1990; Chen et al., 2001; Luckraz et al., 2007), the researchers found that wound infections and complications in PT participants were minimal to nonexistent, demonstrating the ability of PT to promote safe, sanitary wound healing in various surgical settings.

Compared with sutures, PT offers medical and monetary advantages for wound closure. When comparing the application of PT to sutures, Chen et al. (2001) and Luckraz et al. (2007) found that the time for wound closure for the PT group was statistically significantly shorter than the sutures group, without any significant differences in wound complications. Chen et al. (2001) found a statistically significant reduction in patient pain when removing PT compared with suture removal, whereas Luckraz et al. (2007) found the per patient cost of wound closure was significantly lower with PT than with sutures. These results point to PT as the optimal wound closure technique, as it reduces skin closure time, pain during removal, and health care costs. Notably, the researchers used different types of PT. Chen et al. (2001) used Micropore hypoallergenic tape, whereas Luckraz et al. (2007) used Steri-Strips. This may suggest that any type of PT is preferable to sutures; however, the absence of additional studies evaluating PT compared with sutures and replicating this finding hinders the ability to draw this comparison.

This review also supports the use of PT in the long-term management of scars. To promote more aesthetically favorable outcomes, Atkinson et al. (2005), Ishii et al. (2021), Lin et al. (2020), Reiffel (1995), and Sugamata et al. (2012) applied PT after the sutures had been removed or the wound had been closed for a long duration of time. The application of PT was maintained for a number of weeks, months, or years depending on the type of scarring the researchers aimed to prevent (i.e., hypertrophic or keloid). Hypertrophic scars required weeks to months to effect change, whereas keloid scars required years. When the researchers used PT to prevent hypertrophic scarring (Atkinson et al., 2005; Ishii et al., 2021; Lin et al., 2020; Reiffel, 1995), the PT was kept on for a minimum of 2 months and a maximum of 6 months, with 3 months being the most common duration of application (Atkinson et al., 2005; Lin et al., 2020). To prevent keloid scars, Reiffel (1995) kept the PT on for 2 or 4 years. All of these researchers found that applying PT was associated with favorable aesthetic results and reported significant reductions in scar measurements and/or high satisfaction with scar aesthetics.

PT improved scar outcomes when compared with other scar management methods and applied as a singular intervention. Atkinson et al. (2005) demonstrated that applying PT was superior to no intervention. In this study, the PT group had significantly lower scar volume, lower odds of hypertrophic scarring, and even prevention of hypertrophic scarring. Lin et al. (2020) did not find statistically significant differences in VSS scores between groups when comparing the use of PT with using silicone sheets for scar management. The researchers deemed the significantly better VAS scores of the silicone sheet group too small to be clinically meaningful. Thus, when presented with the choice of using PT or silicone sheets, the comparable levels of efficacy may encourage physicians to opt for the lower cost option of PT. None of the studies included in this review reported significant differences in pruritus or pain associated with hypertrophic scarring.

Comparing two different kinds of PT suggests that the base material of the tape may enhance scar outcomes. Ishii et al. (2021) found hypoallergenic polyester-woven tape to be significantly better for improving scar appearance and reducing skin complications than nonwoven surgical tape, despite having no significant differences in scar width between groups. This finding may offer insights into the physical properties of the base material that prevent hypertrophic scarring and skin complications, as well prompt further study into this phenomenon.

Ultimately, postoperative healing of open wounds can be conceptualized as a timeline that starts with wound closure and then proceeds to scar development and scar maturation. PT presents short-and long-term benefits when applied at different points along this timeline, with earlier application promoting faster wound closure with minimal skin complications and infections and later application promoting a flatter, softer, and less pigmented scar appearance that garners widespread patient approval. Notably, the objectives of wound closure and scar management are not mutually exclusive. Chen et al. (2001) utilized PT for the purpose of wound closure but reported its effects on both. In this comparative study, the researchers applied either PT or sutures for 7–10 days. They reported no differences in wound complication rates or scar width between groups at 6 months postoperatively, but the PT group reported significantly higher scar satisfaction. In addition, participants in the Chen et al. (2001) study were more satisfied with scar outcomes following PT application and participants in the Atkinson et al. (2005) study were satisfied with the ability of PT to reduce scar volumes. This suggests a more prolonged PT application may be useful for improving both wound closure and scar management.

Limitations

Limitations of this study include the fact that the variations in PT application complicated a comparison of outcomes. For instance, some researchers applied PT to promote wound closure (Chao & Tsaez, 1990; Chen et al., 2001; Luckraz et al. 2007), whereas others applied PT to promote scar management (Atkinson et al., 2005; Ishii et al., 2021; Lin et al., 2020; Reiffel, 1995; Sugamata et al., 2012). In addition, the researchers who employed the same approach to studying PT application did not assess the same variables, did not apply the same scale, did not apply the PT for the same duration, or did not apply PT with the same base material. Although the heterogeneous approaches to studying the influence of PT application allow a wider array of data to be collected, more uniform application of standardized outcome measures would enhance the ability of health care providers to compare wound closure techniques and improve patients’ scar appearances.

Furthermore, the generalizability of these results is limited by the small, racially homogeneous sample sizes of the studies. Five of eight studies were conducted in Japan (Ishii et al., 2021; Sugamata et al., 2012) and Taiwan (Chao & Tsaez, 1990; Chen et al., 2001; Lin et al., 2020). Only two researchers reported the racial compositions of their samples: Atkinson et al. (2005) reported that all participants were of Caucasian descent, whereas Lin et al. (2020) reported that all participants were of Asian descent. The literature has found that patients with darker skin tones are at a greater risk for hypertrophic and keloid scarring (Brown & Bayat, 2009; Lawrence et al., 2012; Madu & Kundu, 2014; Ud-Din & Bayat, 2014). Future studies on the efficacy of PT application must consider the heightened vulnerability of patients with darker skin tones to adverse scarring outcomes and make a concerted effort to include them in patient samples.

Additional Considerations

The following studies, classified as qualitative synthesis in Figure 1, do not necessarily fit the scope of this review but warrant discussion for their demonstration of PT’s broad utility and effect on the skin of certain populations. Several articles offer insights into a possible underlying mechanism by which PT prevents skin dehiscence and scar coarseness. Lipman et al. (2014, 2016) found that PT significantly decreased the formation of blisters in ultramarathon and endurance runners. The researchers attributed this finding to the ability of PT to reduce friction and abrasion from neighboring surfaces and friction directly below the application site. PT has also been used to immobilize adjacent skin during tumor excision procedures (Moon et al., 2017). Similarly, Atkinson et al. (2005) reported that using PT prevents hypertrophic scarring by reducing scar tension. When paired with the conclusions obtained from Lipman et al. (2014, 2016), this finding corroborates the manner in which PT protects and stabilizes the skin during periods or activities that exert mechanical forces above or beneath the skin’s surface. Thus, PT may have even more widespread utility for athletes and patients undergoing various procedures where this reduction of tension is necessary or advantageous.

In addition, Chapman and Zug (2000), Grove et al. (2013, 2014), de Oliviera Marcatto et al. (2021), and Ratliff (2017) evaluated skin reactions associated with PT, specifically medical adhesive-related skin injuries (MARSI) and dermatitis. Collectively, these researchers suggest that health care providers should consider the risk of skin reactions that may occur during PT application or removal in neonates, infants, and children, adults older than 55 years, and patients with peripheral vascular disease. Grove et al. (2013) demonstrated that silicone tape may be a gentler alternative to PT for use in these subsets of patients. Still, compared with plastic and transparent tapes, PT produces lower rates of dermatitis and prevents transepidermal water loss (Chapman & Zug, 2000). Atkinson et al. (2005) deemed the latter benefit conferred by PT to be influential in scar maturation and improved appearance.

CONCLUSION

The available data show that the use of PT in the postoperative setting is safe, effective, cost-effective, and therefore useful for reducing wound complications and optimizing scar aesthetics. The limited amount of high-quality data; however, indicates the need for additional studies, including randomized controlled trials and trials that study more racially diverse populations, to evaluate this promising approach more rigorously.