Longitudinal burn scar quantification.
Quantitative studies of the clinical recovery of burn scars are currently lacking. Previous reports validate the objective, precise, diagnostic capabilities of high-frequency ultrasound to measure thickness, the Cutometer(®) to measure pliability and the Mexameter(®) to measure erythema and pigmentation of scars. Thus, we prospectively quantified clinical characteristics of patient-matched, after burn hypertrophic scar (HSc), donor site scar (D) and normal skin (N) using these instruments. One investigator measured 3 sites (HSc, D, N) in 46 burn survivors at 3, 6, and 12 months after-burn. A mixed model regression analysis, adjusting p-values for multiplicity of testing, was used to compare means among sites and time points. Participants were 41.2±13.5 years old, 87% males, predominantly Caucasian, with an average of 19.5% body surface area burned. HSc thickness decreased significantly between 3 and 6, 6 and 12, and 3 and 12 months (all p<0.0001), but remained thicker than D and N skin (all p<0.0001). Pliability differed significantly between HSc, D and N sites at all time points (all p<0.0001), with HSc and D increasing between 3 and 12 months (p<0.05) but not reaching normal. HSc and D sites were significantly more erythematous than normal skin (p<0.05) at 3 and 6 months but D sites approached normal by 12 months. The only time points at which pigmentation significantly differed were the HSc and D sites at 6 months. Thickness, pliability, erythema and pigmentation of N skin remained similar over the 12 months. We found that post-burn HSc thickness, pliability and erythema differed significantly from D and N skin at 3, 6, and 12 months and does not return to normal by 12 months after-injury; however, significant improvements towards normal can be expected. Donor sites are redder than normal skin at 3 and 6 months but can be expected to return to normal by 12 months. Although the color of HSc and D sites change markedly with time these color changes are primarily due to changes in redness of the site, not melanin in this primarily Caucasian population.
School of Physical and Occupational Therapy, McGill University, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada; Hôpital de réadaptation Villa Medica, Canada. Electronic address: bernadette.nedelec@mcgill.ca.
Bernadette
B
Nedelec
Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
José A
JA
Correa
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada; Hôpital de réadaptation Villa Medica, Canada.
Ana
A
de Oliveira
Hôpital de réadaptation Villa Medica, Canada.
Leo
L
LaSalle
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada.
Isabelle
I
Perrault
D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D017439:Cicatrix, Hypertrophic / Q000473:pathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation; D055815:Young Adult
Burns; Cutometer; High-frequency ultrasound scanning; Hypertrophic scar; Mexameter; Skin injuries