Subjective Tools for Burn Scar Assessment: An Integrative Review

Keloid and Hypertrophic Scars Treatment

BACKGROUND

Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen.

OBJECTIVE

To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device.

METHODS

Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3-1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded.

RESULTS

A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics.

CONCLUSIONS

The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy of Fractional Micro-plasma Radio Frequency Technology in Treating Hypertrophic Burn Scars in Asian Patients Under General Anesthesia: A Retrospective Study of 104 Cases

BACKGROUND

Laser and other energy devices have been widely used in the minimally invasive treatment of scars. Among various technologies, Fractional Micro-Plasma Radio Frequency Technology (FMRT) has gained extensive consensus in the treatment of various types of scars and skin disorders, such as wrinkles, skin laxity, and pigmentation.

OBJECTIVE

This study is a retrospective clinical trial aimed at assessing the effectiveness and safety of FMRT for hypertrophic burn scars treatment in the Asian population under different anesthesia methods.

METHODS

A total of 104 patients with hypertrophic burn scars treated in our department from May 2018 to May 2022 were selected. Scar assessment scales were applied to observe changes in scars before and after FMRT treatment.

RESULTS

A prospective study of 104 patients found that female patients were more likely to undergo laser treatment under general anesthesia (P < 0.05). Postoperative VSS total score, VSS total score difference, and immediate postoperative pain score were all better with general anesthesia compared to local anesthesia (P < 0.05). There were more significant improvements in scar color, vascular distribution, and flexibility (P < 0.05). When comparing the treatment outcomes between females and males, it was found that general anesthesia patients were superior to local anesthesia patients in terms of color score, vascular distribution score, flexibility score, and postoperative VSS total score 6 months after the final treatment. General anesthesia patients had a shorter hospital stay. Overall treatment evaluation was better for female general anesthesia patients than male patients.

CONCLUSION

General anesthesia combined with FMRT is an effective, safe, and more acceptable treatment method for hypertrophic burn scars in the Asian population.

BULLET POINTS

In the Asian population, the combined use of general anesthesia and Fractional Micro-Plasma Radio Frequency Technology (FMRT) is an effective, safe, and accepted method for treating skin scars.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Comprehensive Review of Evaluating Donor Site Morbidity and Scar Outcomes in Skin Transfer Techniques

This comprehensive review delves into the intricacies of donor site morbidity and scar outcomes in skin transfer techniques central to the field of reconstructive surgery. The review synthesizes existing literature to illuminate the multifaceted factors influencing outcomes by surveying a broad spectrum of grafting methods, from traditional autografts to cutting-edge tissue engineering approaches. Key findings underscore the complex interplay of graft characteristics, surgical techniques, and patient-specific variables. The implications for clinical practice advocate for a nuanced, patient-centered approach, incorporating emerging minimally invasive procedures and adjuvant therapies. The review concludes with recommendations for future research, emphasizing the importance of longitudinal studies, comparative analyses, patient-reported outcomes, advanced imaging techniques, and exploration of tissue engineering innovations. This synthesis advances our understanding of donor site morbidity and scar outcomes. It provides a roadmap for refining clinical protocols, ultimately enhancing the delicate balance between therapeutic efficacy and patient well-being in reconstructive surgery.

Re-recognition of the role of roughness in keloid assessment

BACKGROUND

Under visual observation, keloids are more rough than normal skin. This roughness may be used to assess the activity and severity of keloids but lacks the support of objective and accurate evidence. The purpose of this study was to verify the role of roughness in the development of keloids and to clarify the advantage of roughness in the comprehensive assessment of keloids.

METHODS

Patients with keloids who attended Peking Union Medical College Hospital were recruited. Keloids were classified into progressive, stable, and atrophic stages based on the change in size over the past year and blood perfusion. The keloids were evaluated using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The roughnesses of the keloid and normal skin were measured using the Phaseshift Rapid In vivo Measurement Of the Skin (PRIMOS), and blood perfusion was measured using laser speckle contrast imaging (LSCI).

RESULTS

Thirty-three patients with a total of 81 keloids were included. The surface roughness values Sa, Sq, and Sz of the keloid region were 243.70 (143.85-328.05), 316.20 (179.85-475.20), and 1708.20 (1098.30-4087.20), respectively, which were 4.87, 4.80, and 3.08 times higher than those of normal skin. There were significant differences in roughness among the different keloid stages. A significantly strong correlation between roughness and other assessed indices was found.

CONCLUSIONS

Roughness as a morphological characteristic is of great value in the evaluation of keloids. It is recommended as an important examination for keloids.

In vivo burn scar assessment with speckle decorrelation and joint spectral and time domain optical coherence tomography

Significance

Post-burn scars and scar contractures present significant challenges in burn injury management, necessitating accurate evaluation of the wound healing process to prevent or minimize complications. Non-invasive and accurate assessment of burn scar vascularity can offer valuable insights for evaluations of wound healing. Optical coherence tomography (OCT) and OCT angiography (OCTA) are promising imaging techniques that may enhance patient-centered care and satisfaction by providing detailed analyses of the healing process.

Aim

Our study investigates the capabilities of OCT and OCTA for acquiring information on blood vessels in burn scars and evaluates the feasibility of utilizing this information to assess burn scars.

Approach

Healthy skin and neighboring scar data from nine burn patients were obtained using OCT and processed with speckle decorrelation, Doppler OCT, and an enhanced technique based on joint spectral and time domain OCT. These methods facilitated the assessment of vascular structure and blood flow velocity in both healthy skin and scar tissues. Analyzing these parameters allowed for objective comparisons between normal skin and burn scars.

Results

Our study found that blood vessel distribution in burn scars significantly differs from that in healthy skin. Burn scars exhibit increased vascularization, featuring less uniformity and lacking the intricate branching network found in healthy tissue. Specifically, the density of the vessels in burn scars is 67% higher than in healthy tissue, while axial flow velocity in burn scar vessels is 25% faster than in healthy tissue.

Conclusions

Our research demonstrates the feasibility of OCT and OCTA as burn scar assessment tools. By implementing these technologies, we can distinguish between scar and healthy tissue based on its vascular structure, providing evidence of their practicality in evaluating burn scar severity and progression.

The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction

In facial reconstruction after skin cancer resection, management and optimization of postoperative scar is a complex paradigm. Every scar is unique and presents a different challenge-whether due to anatomic, aesthetic, or patient-specific factors. This necessitates a comprehensive evaluation and an understanding of the tools at hand to improve its appearance. How a scar looks is meaningful to patients, and the facial plastic and reconstructive surgeon is tasked with its optimization. Clear documentation of a scar is critical to assess and determine optimal care. Scar scales such as the Vancouver Scar Scale, the Manchester Scar Scale, the Patient and Observer Assessment Scale, the Scar Cosmesis Assessment and Rating "SCAR" Scale, and FACE-Q, among others, are reviewed here in the context of evaluating postoperative or traumatic scar. Measurement tools objectively describe a scar and may also incorporate the patient's assessment of their own scar. In addition to physical exam, these scales quantify scars that are symptomatic or visually unpleasant and would be best served by adjuvant treatment. The current literature regarding the role of postoperative laser treatment is also reviewed. While lasers are an excellent tool to assist in blending of scar and decreasing pigmentation, studies have failed to evaluate laser in a consistent, standardized way that allows for quantifiable and predictable improvement. Regardless, patients may derive benefit from laser treatment given the finding of subjective improvement in their own perception of scar, even when there is not a significant change to the clinician's eye. This article also discusses recent eye fixation studies which demonstrate the importance of careful repair of large and central defects of the face, and that patients value the quality of the reconstruction.

Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey

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.