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Minic J, Vigato E, Shoham Y, Lavagnolo U, Governa M. Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations. Health Sci Rep 2024; 7:e1829. [PMID: 39040879 PMCID: PMC11260873 DOI: 10.1002/hsr2.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 07/24/2024] Open
Abstract
Background Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. Methods A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. Results All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Conclusion Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.
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Affiliation(s)
| | | | - Yaron Shoham
- Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
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Legemate CM, Middelkoop E, Carrière ME, van Zuijlen PPM, van Baar ME, van der Vlies CH. The minimal important change (MIC) and minimal clinically important difference (MCID) of the patient and observer scar assessment scale (POSAS) 2.0. Burns 2024:S0305-4179(24)00170-0. [PMID: 38902132 DOI: 10.1016/j.burns.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The Patient and Observer Scar Assessment Scale (POSAS) is frequently used to assess scar quality after burns. It is important to be aware of the minimal important change (MIC) and the minimal clinically important difference (MCID) to establish if a POSAS score represents a clinically relevant change or difference. The aim of this study is to explore the MIC and MCID of POSAS version 2.0. METHODS This prospective study included 127 patients with deep dermal burns that underwent split thickness skin grafting with a mean age of 44 years (range 0 - 87) and total body surface area burned of 10 % (range 0.5 - 55). POSAS data was obtained for one burn scar area at three, six, and 12 months after split skin grafting. At the second and third visits, patients rated the degree of clinical change in scar quality in comparison to the previous visit. At 12 months, they completed the POSAS for a second burn scar area and rated the degree of clinical difference between the two scar areas. Two anchor-based methods were used to determine the MIC and MCID. RESULTS MIC values of the patient POSAS ranged from - 0.59 to - 0.29 between three and six months and from - 0.75 to - 0.38 between six and 12 months follow-up. Both had a poor discriminatory value. MCID values ranged from - 0.39 and - 0.08, with a better discriminatory value. CONCLUSION Results suggest that patients consider minor differences (less than 0.75 on the 1-10 scale) in POSAS scores as clinically important scar quality changes. MCID values can be used to evaluate the effects of burn treatment and perform sample-size calculations.
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Affiliation(s)
- Catherine M Legemate
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands.
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - Michelle E Carrière
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, the Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Noord-Holland, the Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Noord-Holland, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - Margriet E van Baar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
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Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Cai LZ, Caceres M, Dangol MK, Nakarmi K, Rai SM, Chang J, Gibran NS, Pham TN. Accuracy of remote burn scar evaluation via live video-conferencing technology. Burns 2024; 50:781-788. [PMID: 27931764 DOI: 10.1016/j.burns.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Telemedicine in outpatient burn care, particularly in burn scar management, may provide cost-effective care and comes highly rated by patients. However, an effective scar scale using both video and photographic elements has not been validated. The purpose of this study is to test the reliability of the Patient and Observer Scar Assessment Scale (POSAS) using live video-conferencing. METHODS A prospective study was conducted with individuals with healed burn scars in Kathmandu, Nepal. Three independent observers assessed 85 burn scars from 17 subjects, using the Observer portion to evaluate vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion. The on-site observer was physically present with the subjects and used a live videoconferencing application to show the scars to two remote observers in the United States. Subjects used the Patient portion to evaluate the scar that they believed appeared the worst appearance and had the greatest impact on function. RESULTS The single-rater reliability of the Observer scale was acceptable (ICC>0.70) in overall opinion, thickness, pliability, and surface area. The average-rater reliability for three observers was acceptable (ICC>0.70) for all parameters except for vascularity. When comparing Patients' and Observers' overall opinion scores, patients consistently reported worse opinion. CONCLUSIONS Evaluation of burn scars using the Patient and Observer Scar Assessment Scale can be accurately performed via live videoconferencing and presents an opportunity to expand access to burn care to rural communities, particularly in low- and middle-income countries, where patients face significant access barriers to appropriate follow-up care.
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Affiliation(s)
- Lawrence Z Cai
- Stanford School of Medicine, Stanford University, United States.
| | - Maria Caceres
- University of Washington Regional Burn Center, United States
| | - Mohan Krishna Dangol
- Department of Physical Therapy, Kirtipur Hospital, Nepal; ReSurge International, California, United States
| | - Kiran Nakarmi
- Division of Plastic Surgery, Kirtipur Hospital, Nepal; ReSurge International, California, United States
| | - Shankar Man Rai
- Division of Plastic Surgery, Kirtipur Hospital, Nepal; ReSurge International, California, United States
| | - James Chang
- Department of Surgery, Division of Plastic Surgery, Stanford University, United States; ReSurge International, California, United States
| | - Nicole S Gibran
- University of Washington Regional Burn Center, United States
| | - Tam N Pham
- University of Washington Regional Burn Center, United States
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Scott HC, Robinson LS, Brown T. Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists. HAND THERAPY 2024; 29:21-29. [PMID: 38434186 PMCID: PMC10901164 DOI: 10.1177/17589983231205666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/19/2023] [Indexed: 03/05/2024]
Abstract
Introduction Scar massage is a commonly used treatment in hand therapy. The current empirical evidence that supports it is disparate and of variable quality, with no established effective dosage and method proposed. This study aimed to identify the current practice among Australian hand therapists using massage as an intervention for scarring following surgery to the hand and upper limb. Methods A purposely designed self-report online survey was emailed to current members of the Australian Hand Therapy Association (n = 958). Data collected included demographics, intervention techniques, conditions treated and protocols, scar assessment and knowledge and training about scar massage as a clinical intervention. Results A total of 116 completed questionnaires were received (a response rate of 12.1%). All respondents used scar massage as part of their clinical practice with 98% to improve soft tissue glide (n = 114), 92% for hypersensitivity (n = 107), and 84% to increase hand function (n = 97). Only 18% (n = 21) of respondents used standardised outcome measures, and most therapists had learned scar massage from a colleague (81%). Conclusions Commonalities in how respondents implemented scar massage were found. Participants reported relying primarily on clinical experience to inform their practice. Whilst scar massage was widely used, few respondents had received formal skills training or completed outcome measures regularly to formally evaluate its clinical efficacy or impact. Replication of this study with a larger international sample of participants is warranted to determine if these findings reflect general practice.
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Affiliation(s)
- Helen C Scott
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, VIC, Australia
| | - Luke S Robinson
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
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Fujimoto Y, Yuri Y, Kato Y, Kinoshita S, Tamiya H. Intra- and inter-rater reliabilities of skin mechanical properties measured in healthy individuals using skin elasticity meter. Ann Med 2023; 55:2279747. [PMID: 37967233 PMCID: PMC10653741 DOI: 10.1080/07853890.2023.2279747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE The aim of this study is to establish a standardized measurement method and to examine the intra- and inter-reliabilities and absolute reliability of measuring skin mechanical properties using a skin elasticity meter (Cutometer®). METHODS Ten healthy participated in the study. Skin mechanical properties were measured at four sites: upper arm, lower arm, upper leg and lower leg on both sides in supine position using a non-invasive skin elasticity meter by two trained different raters. The measurements include quantitative indices of the maximal distensibility (R0), elasticity (R2, R5, R7), and viscoelasticity (R6). Intra- and inter- relative reliabilities were determined using the intraclass correlation coefficient (ICC) (1,1) and ICC (2,1) methods, respectively. The absolute reliability was assessed via the Bland-Altman analysis. Moreover, we evaluated the minimal detectable change at a 95% confidence level (MDC95). RESULTS At each site, the ICC (1,1) values were >0.90, and the ICC (2,1) values were >0.50. The Bland-Altman analysis did not reveal any fixed errors, and several sites and parameters have proportional errors. CONCLUSIONS In this study, intra- and inter-reliabilities were measured at "excellent" and more than "moderate" levels, respectively. However, because some proportional errors were observed, the limits of reliability agreement should be considered when using the proposed methods. We believe that the results of this study can be applied to clinical research in field of rehabilitation treatment.
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Affiliation(s)
- Yudai Fujimoto
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshimi Yuri
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Yuji Kato
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Shota Kinoshita
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Hironari Tamiya
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
- Department of Orthopaedic surgery (Musculoskeletal Oncology Service), Osaka International Cancer Institute, Osaka, Japan
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Zheng W, Xu W, Zhou X, Li H, Li P, Xu Q. Application of 3D Transparent Facemasks in Long-Term Outpatient Rehabilitation of Facial Scars After Burns: A Retrospective Cohort Study of Improved Appearance of Target Scars With Different Healing Time. J Burn Care Res 2023; 44:1355-1364. [PMID: 37387307 DOI: 10.1093/jbcr/irad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 07/01/2023]
Abstract
Severe facial burns may cause scarring problems and affect living quality of patients. With the advent of 3D facemasks, it is being used to treat facial scars; however, its efficacy must be confirmed by adequate studies. A retrospective analysis of 26 patients who visited rehabilitation outpatient clinic from 2017 to 2022. Patients were separated into two groups based on the time to healing (TTH) following burn injury: early healing group (TTH ≤ 21 days) and late healing group (TTH > 21 days). To compare treatment outcomes and differences between the two groups, 3D facemask application was assessed using the Vancouver Scar Scale (VSS), patient satisfaction, and complications. In both groups, there were significant improvements in the total VSS scores (P < .01) and each VSS subscore (P < .01). These scar characteristics improved over time as the treatment progressed. Compared with the late healing group, the early healing group had more obvious effects on improving scar pigmentation (P < .05) and vascularity (P < .05) at similar assessment time points after burns. At the last assessment, there was a significant difference in total VSS scores between groups (P = .009). For the early and late healing groups, respectively, the mean gradient value (SE) of the total VSS scores was 1.550 (0.373) and 1.283 (0.224) over the course of the treatment periods. 3D facemasks are effective in the rehabilitation of facial scars caused by burns, which should be used for prevention and treatment in the initial stages of scar development.
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Affiliation(s)
- Weiting Zheng
- Department of Burn, The First Affiliated Hospital of Anhui Medical University
| | - Wanting Xu
- Department of Burn, The First Affiliated Hospital of Anhui Medical University
| | - Xianliang Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Hua Li
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Pengtao Li
- Department of Burn, The First Affiliated Hospital of Anhui Medical University
| | - Qinglian Xu
- Department of Burn, The First Affiliated Hospital of Anhui Medical University
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Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns. Life (Basel) 2023; 13:life13030762. [PMID: 36983917 PMCID: PMC10053383 DOI: 10.3390/life13030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children’s scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents’ opinion (Patient Scale: 2.95 and 4.45, p = 0.181).
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Klimitz FJ, Neubauer H, Stolle A, Ripper S, Daeschler SC, Aman M, Boecker A, Thomas B, Kneser U, Harhaus L. Objective Burn Scar Assessment in Clinical Practice Using the Cutometer©: Introduction and Validation of a Standardized Measurement Protocol. J Burn Care Res 2022; 44:95-105. [PMID: 36300728 PMCID: PMC9825325 DOI: 10.1093/jbcr/irac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 01/12/2023]
Abstract
An objective burn scar assessment is essential to informed therapeutic decision-making and to monitor scar development over time. However, widely employed scar rating scales show poor inter-rater reliability. For this study we developed a standardized measurement protocol for the Cutometer© applicable for objective burn scar assessment in everyday clinical practice. We developed a measurement protocol for the Cutometer© MPA 580 including a scar site relocation technique based on anatomical landmarks. The protocol emerged through several steps: Identifying key factors for valid and reliable measurements, preliminary testing, specification of technical details, refining the protocol and final testing. Consecutively, the protocol was validated for inter-rater reliability by assessing 34 burn scars in 17 patients by four clinicians and computing an Intra-class Correlation Coefficient (ICC). Parameter R0, representing scar pliability, was identified as the best suited output parameter yielding excellent inter-rater reliability for average measures (ICC 0.92 [95% CI 0.86; 0.96]) and acceptable reliability for single measures (ICC: 0.74 [0.61; 0.84]). The pressure applied on the measuring probe was identified as an influential confounding factor for reliable measurements. Rater gender did not influence reliability of measurements. The introduced standardized measurement protocol for the Cutometer© MPA 580 enables an objective and reliable burn scar assessment for clinical as well as research purposes.
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Affiliation(s)
- Felix J Klimitz
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Hubert Neubauer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Annette Stolle
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sabine Ripper
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Simeon C Daeschler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Martin Aman
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Arne Boecker
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany,Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Leila Harhaus
- Address correspondence to Leila Harhaus, MD, Vice Chair, Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. Presented at: 38th Annual Conference of the German Association of Burn Treatment (DAV) 2020 in Zell am See, Austria, Best Paper Award, IFSSH/IFSHT Triennial Congress 2019 in Berlin, Germany
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Prevalence and Severity of Burn Scars in Rural Mozambique. World J Surg 2022; 46:2561-2569. [PMID: 35947179 PMCID: PMC9529692 DOI: 10.1007/s00268-022-06682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 12/02/2022]
Abstract
Background Burn injuries are common in low- and middle-income countries (LMICs) and their associated disability is tragic. This study is the first to explore burn scars in rural communities in Mozambique. This work also validated an innovate burn assessment tool, the Morphological African Scar Contractures Classification (MASCC), used to determine surgical need. Methods Using a stratified, population-weighted survey, the team interviewed randomly selected households from September 2012 to June 2013. Three rural districts (Chókwè, Nhamatanda, and Ribáuè) were selected to represent the southern, central and northern regions of the country. Injuries were recorded, documented with photographs, and approach to care was gathered. A panel of residents and surgeons reviewed the burn scar images using both the Vancouver Scar Scale and the MASCC, a validated visual scale that categorizes patients into four categories corresponding to levels of surgical intervention. Results Of the 6104 survey participants, 6% (n = 370) reported one or more burn injuries. Burn injuries were more common in females (57%) and most often occurred on the extremities. Individuals less than 25 years old had a significantly higher odds of reporting a burn scar compared to people older than 45 years. Based on the MASCC, 12% (n = 42) would benefit from surgery to treat contractures. Conclusion Untreated burn injuries are prevalent in rural Mozambique. Our study reveals a lack of access to surgical care in rural communities and demonstrates how the MASCC scale can be used to extend the reach of surgical assessment beyond the hospital through community health workers. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06682-y.
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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12
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Correlation between elastic modulus and clinical severity of pathological scars: a cross-sectional study. Sci Rep 2021; 11:23324. [PMID: 34857833 PMCID: PMC8639709 DOI: 10.1038/s41598-021-02730-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022] Open
Abstract
Though widely used to assess pathological scars, the modified Vancouver Scar Scale (mVSS) is neither convenient nor objective. Shear wave elastography (SWE) is used to evaluate the stiffness of pathological scars. We aimed to determine the correlation between mVSS score and elastic modulus (EM) measured by SWE for pathological scars. Clinical information including ultrasound (US) results of the enrolled patients with pathological scars was analyzed. The clinical severity of the pathological scars was evaluated by mVSS. Skin stiffness, as represented by EM, was calculated using SWE. The average EM of the whole scar (EMWHOLE), hardest part of the scar (EMHARDEST), and normal appearance of the skin around the scar (EMNORMAL) were also recorded. Enrolled in this study were 69 pathological scars, including 28 hypertrophic scars and 41 keloids. The univariable regression analyses showed that the EM of pathological scars was closely related to mVSS score, while the linear multivariable regression analyses showed no significantly correlation. Curve fitting and threshold effect analysis revealed that when EMWHOLE was less than 166.6 kPa or EMHARDEST was less than 133.07 kPa, EM was positively correlated with mVSS score. In stratified analysis, there was no significant linear correlation and threshold effect between EMWHOLE and mVSS score in hypertrophic scars or keloids. However, the fully adjusted smooth curves presented a linear association between mVSS score and EMHARDEST in keloids (the adjusted β [95% CI] was 0.010 [0.001, 0.018]), but a threshold and nonlinear association were found in hypertrophic scars. When EMHARDEST was less than 156.13 kPa, the mVSS score increased along with the hardest scar part stiffness; the adjusted β (95% CI) was 0.024 (0.009, 0.038). In conclusion, EM of pathological scars measured by SWE were correlated with mVSS within a threshold range, and showed different association patterns in hypertrophic scars and keloids.
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13
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Choo AMH, Ong YS, Issa F. Scar Assessment Tools: How Do They Compare? Front Surg 2021; 8:643098. [PMID: 34250003 PMCID: PMC8260845 DOI: 10.3389/fsurg.2021.643098] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.
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Affiliation(s)
| | - Yee Siang Ong
- Department of Plastics, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fadi Issa
- Department of Plastic Surgery and Burns, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.,Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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14
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Price K, Moiemen N, Nice L, Mathers J. Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study. BURNS & TRAUMA 2021; 9:tkab005. [PMID: 34212058 PMCID: PMC8240530 DOI: 10.1093/burnst/tkab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Indexed: 02/03/2023]
Abstract
Background Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation. Methods Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted. Results Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties. Conclusions Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.
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Affiliation(s)
- Kate Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Nice
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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15
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Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Response to Vercelli et al. re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis". J Altern Complement Med 2021; 27:374-376. [PMID: 33826859 DOI: 10.1089/acm.2020.29089.cde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlina Deflorin
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Erich Hohenauer
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland
| | - Rahel Stoop
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Ulrike van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Oscare, Organization for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Ron Clijsen
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland.,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
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16
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Mc Kittrick A, Gustafsson L, Marshall K. A systematic review to investigate outcome tools currently in use for those with hand burns, and mapping psychometric properties of outcome measures. Burns 2020; 47:295-314. [PMID: 32826095 DOI: 10.1016/j.burns.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/18/2020] [Accepted: 07/10/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Severe burn injuries to the hand impact multiple domains of function and participation. Measurement of outcomes after hand burn injuries is multifaceted and is influenced by several variables. OBJECTIVE The aim of this systematic review was to review outcome measures reported in studies used to measure outcomes after severe hand burn injuries; and to critically evaluate the reliability, validity and clinical utility of each hand assessment tool identified from the literature to determine suitability for use with the burn's population. DATA SOURCES A search of the published literature using electronic data bases MEDLINE, CINAHL, PEDro, OT seeker and PubMed was undertaken. Studies were included if they reported assessment tools and outcome measures used to determine hand function after severe burn injuries; were published in English and available in their full-length. Studies were excluded if they were related to a group under 18 years of age. RESULTS Thirty-four papers were included in this systematic review. A total of 25 outcome measures were confirmed for inclusion in this paper and each underwent further evaluation to identify their psychometric properties. LIMITATIONS A factor which could cause bias in this systematic review was the search was restricted to English language journals therefore excluding any primary papers in other languages. Mapping of the outcome measures to the ICF was conducted by the primary author which may give rise to bias however a member checking was conducted in order to remove this bias. CONCLUSIONS This review established that no one outcome measure meets all the psychometric properties of validity, reliability and responsiveness SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42018085059.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, 4029, QLD, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia.
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Nathan, QLD, 4111, Australia; Honorary Associate Professor School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia
| | - Kathryn Marshall
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, 4102, QLD, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia
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17
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Klotz T, Kurmis R. Reliability testing of the Matching Assessment using Photographs of Scars App. Wound Repair Regen 2020; 28:676-683. [PMID: 32347998 DOI: 10.1111/wrr.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
The Matching Assessment using Photographs with Scars assessment tool, published in 2005, enables accurate relocation and reassessment of scars. While used in Australia, uptake has been hampered by its paper manual format. With electronic records and increasing use of smart devices in health, here we report the development of the Matching Assessment using Photographs with Scars manual into a mobile application format: ClinMAPSTM Pro. At the time of development, no other digital scar assessment applications were available. For clinical validation, the digitized Matching Assessment using Photographs with Scars module within ClinMAPSTM Pro was used for intra- and inter-rater reliability testing. Convenience sampling was utilized to recruit burns patients representing 44 scars, based on predetermined power calculations. Three therapists, one experienced and two novice, acted as the assessors. Each therapist assessed preselected scars with the digitized Matching Assessment using Photographs with Scars. Re-assessment of the same scar sites occurred 3 to 7 days later. Inter-rater reliability testing scores of the new electronic assessment application showed fair to moderate agreement (combined Fleiss Kappa = 0.38-0.49, P < .0001). Intra-rater reliability scores between initial and repeat measures showed moderate to almost perfect agreement (Cohen's Kappa = 0.43-0.90, P < .0001). It was noted that for an experienced rater, intra-rater agreement demonstrated substantial to almost perfect agreement. Intraclass correlation coefficients calculated to allow for comparison between other published scar assessment tools demonstrated excellent reliability for all scar assessment parameters for both intra- (=0.76-0.91) and inter- (=0.76-0.98) reliability. Notably, reliability testing results confirm its intra- and inter-rater reliability. Our findings validate this novel concept for digitization of the previously paper-based scar assessment manual and prove that the Matching Assessment using Photographs with Scars within the ClinMAPSTM Pro application is now readily available for clinicians and researchers internationally.
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Affiliation(s)
- Tanja Klotz
- Department of Occupational Therapy, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia.,Adult Burn Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Rochelle Kurmis
- Adult Burn Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
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18
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The Brisbane Burn Scar Impact Profile (child and young person version) for measuring health-related quality of life in children with burn scars: A longitudinal cohort study of reliability, validity and responsiveness. Burns 2019; 45:1537-1552. [DOI: 10.1016/j.burns.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/19/2019] [Accepted: 07/10/2019] [Indexed: 12/24/2022]
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19
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Vana LPM, Battlehner CN, Ferreira MA, Caldini EG, Gemperli R, Alonso N. Comparative long-term study between two dermal regeneration templates for the reconstruction of burn scar contractures in humans: Clinical and histological results. Burns 2019; 46:596-608. [PMID: 31645293 DOI: 10.1016/j.burns.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/15/2019] [Accepted: 09/14/2019] [Indexed: 01/14/2023]
Abstract
The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.
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Affiliation(s)
- Luiz Philipe Molina Vana
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras.
| | - Cláudia Naves Battlehner
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Marcelo Alves Ferreira
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Elia Garcia Caldini
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Rolf Gemperli
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras
| | - Nivaldo Alonso
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras
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20
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Rashaan ZM, Kwa KAA, van der Wal MBA, Tuinebreijer WE, van Zuijlen PPM, Breederveld RS. Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient's perspective. Burns 2019; 45:1283-1290. [PMID: 31176509 DOI: 10.1016/j.burns.2019.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/22/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.
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Affiliation(s)
- Z M Rashaan
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - K A A Kwa
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - M B A van der Wal
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ, Beverwijk, The Netherlands.
| | - W E Tuinebreijer
- Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - P P M van Zuijlen
- Burn Centre and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic and Reconstructive Surgery and MOVE Research Institute, VU University of Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - R S Breederveld
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
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21
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Simons M, Kimble R, McPhail S, Tyack Z. The longitudinal validity, reproducibility and responsiveness of the Brisbane Burn Scar Impact Profile (caregiver report for young children version) for measuring health-related quality of life in children with burn scars. Burns 2019; 45:1792-1809. [PMID: 31147101 DOI: 10.1016/j.burns.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The measurement of health-related quality of life (HRQoL) provides information about the perceived burden of the health condition and treatments from a lived experience. The Brisbane Burn Scar Impact Profile (caregiver report for young children, BBSIP0-8), developed in 2013, is a proxy-report measure of burn scar-specific HRQoL. The aim of this study was to report its psychometric properties in line with an evaluative purpose. METHODS Caregivers of children up to 8 years of age at risk of burn scarring were recruited into a prospective, longitudinal cohort study. Caregivers completed the BBSIP0-8, Pediatric Quality of Life Inventory and Patient Observer Scar Assessment Scale at baseline (approximately ≥85% of the total body surface area re-epithelialised), 1-2 weeks after baseline and 1-month after baseline. Psychometric properties measured included internal consistency, test-retest reliability, validity and responsiveness. RESULTS Eighty-six caregivers of mostly male children (55%), of a median age (IQR) of 1 year, 10 months (2 years, 1 month) and total body surface area burn of 1.5% (3.0%) were recruited. Over one third of participants were grafted and 15% had contractures or skin tightness at baseline. Internal consistency of ten item groups ranged from 0.73 to 0.96. Hypothesised correlations of changes in the BBSIP0-8 items with changes in criterion measures supported longitudinal validity (ρ ranging from -0.73 to 0.68). The majority of item groups had acceptable reproducibility (ICC = 0.65-0.83). The responsiveness of five item groups was supported (AUC = 0.71-0.90). CONCLUSION The psychometric properties tested support the use of the BBSIP0-8 as an evaluative measure of burn scar-related health-related quality of life for children aged below eight years in the early post-acute period of rehabilitation. Further investigation at longer time period after burn injury is indicated.
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Affiliation(s)
- M Simons
- Department of Occupational Therapy, Queensland Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia.
| | - R Kimble
- Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Queensland Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Queensland 4067, Australia.
| | - S McPhail
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia; Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland 4102, Australia.
| | - Z Tyack
- Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia; Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland 4102, Australia.
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22
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Patel SP, Nguyen HV, Mannschreck D, Redett RJ, Puttgen KB, Stewart FD. Fractional CO2 Laser Treatment Outcomes for Pediatric Hypertrophic Burn Scars. J Burn Care Res 2019; 40:386-391. [DOI: 10.1093/jbcr/irz046] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Carbon dioxide ablative fractional laser (CO2-AFL) therapy has not been widely adopted in pediatric burn care given limited outcomes literature and no established guidelines on laser treatment protocols. We present our experience to further elucidate the clinical role of CO2-AFL therapy for pediatric hypertrophic burn scars. We conducted a prospective cohort study of pediatric burn patients undergoing CO2-AFL treatment of hypertrophic, symptomatic burn scars at a tertiary care regional burn center during a 2-year period. Scars were assessed before each treatment using the Patient and Observer Scar Assessment Scale (POSAS), a validated, subjective, comprehensive scar assessment tool. We treated 49 pediatric patients for a total of 180 laser sessions. Burn severity was full thickness (63.6%) or deep partial thickness (47.7%). Observer-rated POSAS scores revealed statistically significant improvements in pigment, thickness, relief, pliability, and surface area after one treatment with continued improvement until the last laser session. Patient-rated POSAS revealed statistically significant improvements in color, stiffness, thickness, and irregularity after laser treatments. Total POSAS improved from 89.6 ± 17.5 to 76.6 ± 16.8 (P < .0001) after one treatment with further improvement to 69.2 ± 14.9 (P < .0001) at the final laser session. We found convincing evidence that CO2-AFL therapy improves hypertrophic burn scars on both patient- and observer-rated scales confirming statistical and clinical significance to both providers and families. These findings demonstrate that CO2-AFL can improve hypertrophic burn scars in pediatric patients providing a lower risk alternative to invasive therapies and a more immediate, efficacious alternative to more conservative scar treatments.
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Affiliation(s)
- Sagar P Patel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ha Vi Nguyen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diana Mannschreck
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine B Puttgen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - F Dylan Stewart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Teplyi V, Grebchenko K. Evaluation of the scars' vascularization using computer processing of the digital images. Skin Res Technol 2018; 25:194-199. [PMID: 30328632 DOI: 10.1111/srt.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The application of new techniques of the scars' correction requires the objective evaluation of their vascularization. OBJECTIVE To evaluate the effectiveness of digital program ImageJ in assessing neovascularization of pathologic scars. MATERIAL AND METHODS In this cross-sectional study, a total of 25 patients with pathologic scars were enrolled. Vessel selection in the first set of digital images of their scars was performed by computer processing started from thresholding with subsequent manual correction. In the second set of the same pictures, Vessel Analysis plugin was used. Comparison of both approaches was performed by three independent investigators. The time required for images processing was measured. RESULTS The average time that image processing and calculation have taken in the first group (753.3 ± 88.02 seconds) was statistically longer (P < 0.0001) than in the second one (358.1 ± 105.91 seconds). Independent investigators scored the precision of vessel selection in the first group as 80.4 ± 9.82, in the second group as 72.6 ± 10.53 (P < 0.0001). Kolmogorov-Smirnov test demonstrated higher precision of vessel selection by method that involves manual correction (P < 0.001). The results of Vascular Density measurements were obviously overestimated in the second group. More expedient looks calculation of the Vascular Length Density: ratio of skeletonized vasculature area to total area. Skeletonization avoids overestimation of Vascular Density, but the density of the vessel mesh can be determined. CONCLUSIONS Computer processing of the scars' digital photographs using ImageJ software gives cheap, technically easy and not cumbersome way of superficial scars' vascularization objectifying. Vessel selection with subsequent manual correction has advantage of higher precision.
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Affiliation(s)
- Valerii Teplyi
- Department of Surgery #2, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Kateryna Grebchenko
- Department of Surgery #2, O.O. Bogomolets National Medical University, Kyiv, Ukraine
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Wasiak J, Tyack Z, Ware R, Goodwin N, Faggion CM. Poor methodological quality and reporting standards of systematic reviews in burn care management. Int Wound J 2017; 14:754-763. [PMID: 27990772 PMCID: PMC7949759 DOI: 10.1111/iwj.12692] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/02/2016] [Indexed: 12/18/2022] Open
Abstract
The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.
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Affiliation(s)
- Jason Wasiak
- Epworth HealthCareRichmondVAAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Children's Health Research CentreThe University of Queensland & Centre for Functioning and Health Research Metro South HealthBrisbaneQLDAustralia
| | - Robert Ware
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
| | | | - Clovis M Faggion
- Department of Periodontology and Restorative Dentistry, Faculty of DentistryUniversity of MunsterMunsterGermany
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25
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Modified Vancouver Scar Scale score is linked with quality of life after burn. Burns 2017; 43:741-746. [DOI: 10.1016/j.burns.2016.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
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Abstract
Upper extremity burns can result in lifelong complications. A comprehensive occupational therapy program is imperative for restoration of arm function. Edema management, splinting, exercise, scar management, and activities of daily living are key treatment elements to achieve optimal postburn outcomes. Proper patient and family education are essential for therapeutic success. Burn recovery requires a commitment to therapeutic techniques that can progress a patient to their maximal independence.
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Affiliation(s)
- Tiffany Williams
- Occupational Therapy Division, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Tanya Berenz
- Occupational Therapy Division, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Simons M, Kee EG, Kimble R, Tyack Z. Ultrasound is a reproducible and valid tool for measuring scar height in children with burn scars: A cross-sectional study of the psychometric properties and utility of the ultrasound and 3D camera. Burns 2017; 43:993-1001. [PMID: 28238405 DOI: 10.1016/j.burns.2017.01.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the reproducibility and validity of measuring scar height in children using ultrasound and 3D camera. METHOD Using a cross-sectional design, children with discrete burn scars were included. Reproducibility was tested using Intraclass Correlation Coefficient (ICC) for reliability, and percentage agreement within 1mm between test and re-test, standard error of measurement (SEM), smallest detectable change (SDC) and Bland Altman limits of agreement for agreement. Concurrent validity was tested using Spearman's rho for support of pre-specified hypotheses. RESULTS Forty-nine participants (55 scars) were included. For ultrasound, test-retest and inter-rater reproducibility of scar thickness was acceptable for scarred skin (ICC=0.95, SDC=0.06cm and ICC=0.82, SDC=0.14cm). The ultrasound picked up changes of <1mm. Inter-rater reproducibility of maximal scar height using the 3D camera was acceptable (ICC=0.73, SDC=0.55cm). Construct validity of the ultrasound was supported with a strong correlation between the measure of scar thickness and observer ratings of thickness using the POSAS (ρ=0.61). Construct validity of the 3D camera was also supported with a moderate correlation (ρ=0.37) with the same measure using maximal scar height. CONCLUSIONS The ultrasound is capable of detecting smaller changes or differences in scar thickness than the 3D camera, in children with burn scars. However agreement as part of reproducibility was lower than expected between raters for the ultrasound. Improving the accuracy of scar relocation may go some way to address agreement.
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Affiliation(s)
- M Simons
- Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia.
| | - E Gee Kee
- Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia.
| | - R Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Lady Cilento Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Queensland 4067, Australia.
| | - Z Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland 4101, Australia.
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Abstract
BACKGROUND The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated. OBJECTIVE To assess the sonographic activity of keloids in comparison with clinical scoring. MATERIALS AND METHODS A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement). RESULTS Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU. CONCLUSION Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.
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29
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Chipp E, Charles L, Thomas C, Whiting K, Moiemen N, Wilson Y. A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts. BURNS & TRAUMA 2017; 5:3. [PMID: 28116323 PMCID: PMC5244545 DOI: 10.1186/s41038-016-0068-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period. METHODS We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. Scar assessment was performed by a senior burns therapist using the Vancouver Scar Scale. RESULTS Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance. CONCLUSIONS The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Elizabeth Chipp
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Lisa Charles
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Clare Thomas
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Kate Whiting
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Naiem Moiemen
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Yvonne Wilson
- Burns Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
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30
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DeJong HM, Phillips M, Edgar DW, Wood FM. Patient opinion of scarring is multidimensional: An investigation of the POSAS with confirmatory factor analysis. Burns 2016; 43:58-68. [PMID: 27576936 DOI: 10.1016/j.burns.2016.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Scarring is a significant consequence for patients following a burn. Understanding how patients perceive the physiological scar and define scar severity may provide valuable information regarding how the scar influences quality of life after burn. The Patient and Observer Scar Assessment Scale was the first scar assessment tool validated to include the patients' evaluation of the scars physical qualities, following a burn. Validation studies of this tool have previously been conducted for a discrete scar-site after burn. The aim of this study was to assess the structural validity of the POSAS to capture the patients' evaluation of the total area of burn scar(s). METHOD Statistical analysis was based on 508 completed POSAS forms from 358 patients. Exploratory factor analysis (EFA) was used initially to identify the number of factors within the tool, then confirmatory factor analysis (CFA) using structural equation modelling explored areas of misfit within each factor and whether the model provided a predicable structure to capture patient perception of scar severity. RESULTS/DISCUSSION The CFA analysis confirmed that a two dimensional model was superior to a unidimensional model when assessing the patient opinion of their total burn scar. The two dimensions were the physical scar (color, stiffness, thickness and irregularity) and the sensory scar (pain and itch). Further strain analysis of the two factor model identified additional domains. Independent factors influenced the perception of color forming a separate subdomain within the physical domain. Color is a visual characteristic, whereas the other three are predominantly tactile characteristics. A significant relationship between thickness and irregularity suggested they may form another subdomain, however further research is required to confirm this. Both pain and itch were recognized as independent, multidimensional latent variables, which require assessment tools with multidimensional structures. CONCLUSIONS When assessing the entire burn scar, three independent dimensions influence patient perception: (1) the physical scar, (2) pain and (3) itch. Within the physical domain, color formed a visual subdomain separate to a tactile subdomain. Further development of these domains within a high-order multi-dimensional structure is recommended.
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Affiliation(s)
- Helen M DeJong
- Perth Scar and Pain Clinic, Mt Pleasant, 6153, WA, Australia; Medical Sciences, Edith Cowan Universtiy, Joondaplup, 6027, WA, Australia; Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia.
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Centre for Medical Research, University of Western Australia, Crawley, 6009, WA, Australia; Royal Perth Hospital, Perth 6000, WA, Australia
| | - Dale W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia.
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Child and Adolescent Health Service of Western Australia, Princess Margaret Hospital, Subiaco, 6008, WA, Australia.
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31
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Goei H, van der Vlies CH, Hop MJ, Tuinebreijer WE, Nieuwenhuis MK, Middelkoop E, van Baar ME. Long-term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study. Wound Repair Regen 2016; 24:721-30. [PMID: 27102976 DOI: 10.1111/wrr.12438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 01/29/2023]
Abstract
The laser Doppler imager is used in cases of indeterminate burn depth to accurately predict wound healing time at an early stage. The laser Doppler imager classifies burns into three estimated healing potentials as follows: high, <14 days; intermediate, 14-21 days; and low, >21 days. At this time, the relationship between these healing potentials and long-term scar quality is unknown. The objective of this study was to determine the long-term scar quality of burns with three distinct healing potentials. The secondary objectives were to compare treatment strategies in intermediate wounds, to study the effect of the timing of surgery on low healing potential wounds and to identify predictors of reduced scar quality. Hence, in a prospective cohort study, scar quality was determined in patients whose burns were assessed with laser Doppler imaging. Scar Quality was assessed with objective and subjective measurement tools, including overall scar quality (Patient and Observer Scar Assessment Scale) as a primary outcome and color and elasticity parameters. A total of 141 patients (>19 months postburn) with 216 scars were included. Wounds with high and intermediate healing potential did not significantly differ regarding scar quality. Wounds with a low healing potential had a significantly lower scar quality. Analysis of 76 surgically treated low healing potential wounds showed no significant differences in the primary outcome regarding the timing of surgery (≤14 days vs. >14). Predictors of reduced long-term scar quality were darker skin type and multiple surgeries. In conclusion, scar quality was strongly related to the healing potential category. Scar quality was very similar in high and intermediate healing potential wounds. No positive effects were found on scar quality or on healing time in surgically treated wounds with intermediate healing potential, advocating a conservative approach. Further studies should focus on the optimal timing of surgery in low healing potential wounds.
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Affiliation(s)
- Harold Goei
- Association of Dutch Burn Centers, Burn Center Maasstad Hospital, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - M Jenda Hop
- Association of Dutch Burn Centers, Burn Center Maasstad Hospital, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wim E Tuinebreijer
- Association of Dutch Burn Centers, Burn Center Red Cross Hospital, Beverwijk, The Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Burn Center Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centers, Burn Center Maasstad Hospital, Rotterdam, The Netherlands
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Busch KH, Bender R, Walezko N, Aziz H, Altintas MA, Aust MC. Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars. Burns 2016; 42:1556-1566. [PMID: 27156803 DOI: 10.1016/j.burns.2016.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/24/2022]
Abstract
Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm2 (15-250cm2) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars.
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Affiliation(s)
- K H Busch
- Department for Plastic and Reconstructive Surgery, Johanniter Hospital, Bonn, Germany
| | - R Bender
- Department for Plastic and Reconstructive Surgery, Johanniter Hospital, Bonn, Germany
| | - N Walezko
- Department for Plastic and Reconstructive Surgery, Johanniter Hospital, Bonn, Germany
| | - H Aziz
- Department for Plastic and Reconstructive Surgery, Johanniter Hospital, Bonn, Germany
| | - M A Altintas
- Department for Plastic and Reconstructive Surgery, Bergmannsheil und Kinderklinik Buer, Gelsenkirchen, Germany
| | - M C Aust
- Department for Plastic and Reconstructive Surgery, Johanniter Hospital, Bonn, Germany.
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Donovan ML, Muller MJ, Simpson C, Rudd M, Paratz J. Interim pressure garment therapy (4-6 mmHg) and its effect on donor site healing in burn patients: study protocol for a randomised controlled trial. Trials 2016; 17:214. [PMID: 27113487 PMCID: PMC4845345 DOI: 10.1186/s13063-016-1329-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/05/2016] [Indexed: 01/04/2023] Open
Abstract
Background Pressure garment therapy (PGT) is well accepted and commonly used by clinicians in the treatment of burns scars and grafts. The medium to high pressures (24–40 mmHg) in these garments can support scar minimisation, and evidence is well documented for this particular application. However, PGT specifically for burn donor sites, of which a sequela is also scarring, is not well documented. This study protocol investigates the impact of a low pressure (4–6 mmHg) interim garment on donor site healing and scarring. With a primary purpose of holding donor dressings in place, the application of the interim pressure garment (IPG) appears to have been twofold. IPGs for donor sites have involved inconsistent application with a focus on securing wound dressing rather than scar management. However, anecdotal and observational evidence suggests that IPGs also make a difference to some patient’s scar outcomes for donor sites. This study protocol outlines a randomised controlled trial designed to test the effectiveness of this treatment on reducing scarring to burn donor sites. Methods/design This study is a single-centre, single (assessor)-blinded, randomised control trial in patients with burns donor sites to their thighs. Patients will be randomly allocated to a control group (with no compression to donor sites) or to an experimental group (with compression to donor sites) as the comparative treatment. Groups will be compared at baseline regarding the important prognostic indicators: donor site location, depth, size, age, and time since graft (5 days). The IPG treatment will be administered post-operatively (on day 5). Follow-up assessments and garment replacement will be undertaken fortnightly for a period of 2 months. Discussion This study focuses on a unique area of burns scar management using a low-pressure tubular support garment for the reduction of donor site scars. Such therapy specifically for donor scar management is poorly represented in the literature. This study was designed to test a potentially cost-effective scar prevention for patients with donor sites to the thigh. No known studies of this nature have been carried out to date, and there is a need for rigorous clinical evidence for low-pressure support garments for donor site scar minimisation. Trial registration Australian New Zealand Clinical Trials Registry identifier ACTRN12610000127000. Registered 8 Mar 2010.
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Affiliation(s)
- Michelle L Donovan
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Herston, QLD, 4029, Australia. .,Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.
| | - Michael J Muller
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Claire Simpson
- Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Michael Rudd
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
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Kahn MB, Mentiplay BF, Clark RA, Bower KJ, Williams G. Methods of assessing associated reactions of the upper limb in stroke and traumatic brain injury: A systematic review. Brain Inj 2016; 30:252-66. [DOI: 10.3109/02699052.2015.1117657] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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35
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Terwee CB, Prinsen CAC, Ricci Garotti MG, Suman A, de Vet HCW, Mokkink LB. The quality of systematic reviews of health-related outcome measurement instruments. Qual Life Res 2015; 25:767-79. [PMID: 26346986 PMCID: PMC4830864 DOI: 10.1007/s11136-015-1122-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Systematic reviews of outcome measurement instruments are important tools for the selection of instruments for research and clinical practice. Our aim was to assess the quality of systematic reviews of health-related outcome measurement instruments and to determine whether the quality has improved since our previous study in 2007. METHODS A systematic literature search was performed in MEDLINE and EMBASE between July 1, 2013, and June 19, 2014. The quality of the reviews was rated using a study-specific checklist. RESULTS A total of 102 reviews were included. In many reviews the search strategy was considered not comprehensive; in only 59 % of the reviews a search was performed in EMBASE and in about half of the reviews there was doubt about the comprehensiveness of the search terms used for type of measurement instruments and measurement properties. In 41 % of the reviews, compared to 30 % in our previous study, the methodological quality of the included studies was assessed. In 58 %, compared to 55 %, the quality of the included instruments was assessed. In 42 %, compared to 7 %, a data synthesis was performed in which the results from multiple studies on the same instrument were somehow combined. CONCLUSION Despite a clear improvement in the quality of systematic reviews of outcome measurement instruments in comparison with our previous study in 2007, there is still room for improvement with regard to the search strategy, and especially the quality assessment of the included studies and the included instruments, and the data synthesis.
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Affiliation(s)
- C B Terwee
- Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - A Suman
- Department of Public Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L B Mokkink
- Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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36
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Comparing outcomes of sheet grafting with 1:1 mesh grafting in patients with thermal burns: A randomized trial. Burns 2015; 41:257-64. [DOI: 10.1016/j.burns.2014.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022]
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Wolf SE, Phelan HA, Arnoldo BD. The year in burns 2013. Burns 2014; 40:1421-32. [PMID: 25454722 DOI: 10.1016/j.burns.2014.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 12/22/2022]
Abstract
Approximately 3415 research articles were published with burns in the title, abstract, and/or keyword in 2013. We have continued to see an increase in this number; the following reviews articles selected from these by the Editor of one of the major journals (Burns) and colleagues that in their opinion are most likely to have effects on burn care treatment and understanding. As we have done before, articles were found and divided into the following topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. The articles are mentioned briefly with notes from the authors; readers are referred to the full papers for details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, United States.
| | - Herbert A Phelan
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, United States
| | - Brett D Arnoldo
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, United States
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Taudorf EH, Danielsen PL, Paulsen IF, Togsverd-Bo K, Dierickx C, Paasch U, Haedersdal M. Non-ablative fractional laser provides long-term improvement of mature burn scars--a randomized controlled trial with histological assessment. Lasers Surg Med 2014; 47:141-7. [PMID: 25154734 DOI: 10.1002/lsm.22289] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Non-ablative fractional laser-treatment is evolving for burn scars. The objective of this study was to evaluate clinical and histological long-term outcome of 1,540 nm fractional Erbium: Glass laser, targeting superficial, and deep components of mature burn scars. MATERIALS & METHODS Side-by-side scar-areas were randomized to untreated control or three monthly non-ablative fractional laser-treatments using superficial and extra-deep handpieces. Patient follow-up were at 1, 3, and 6 months. Primary outcome was improvement in overall scar-appearance on a modified-Patient-and-Observer-Scar-Assessment-Scale (mPOSAS, 1 = "normal skin", 10 = "worst imaginable scar"). Secondary outcomes included histology, patient satisfaction (0-10), patient-assessed improvement, and safety. RESULTS Study was completed by 17 of 20 randomized patients with normotrophic (n = 11), hypertrophic (n = 5) or atrophic (n = 1) scars. Scar-appearance improved from laser-treatments (P < 0.001 vs. untreated) and histology at 6 months supported collagen-remodeling. Improvement appeared continuously during the post-operative period (mPOSAS baseline: 7 [5-8], 6 months: 4 [3-5] P = < 0.001). At 6 months, patients were satisfied with treatment (6 [3-9]) and 82% reported improved scar-texture. Treatments caused mild to moderate pain (4 [2-7]). Adverse effects decreased during follow-up and at final assessment, discrete erythema, hyperpigmentation or imprints from laser-grid were present in 11 patients. No patients experienced worsening of scar-appearance. CONCLUSIONS Combined superficial and deep non-ablative fractional laser-treatments induce long-term clinical and histological improvement of mature burn scars.
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Affiliation(s)
- Elisabeth H Taudorf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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