Long-term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study.
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.
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.
Harold
H
Goei
Burn Center, Maasstad Hospital, Rotterdam, The Netherlands.
Cornelis H
CH
van der Vlies
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
MJ
Hop
Association of Dutch Burn Centers, Burn Center Red Cross Hospital, Beverwijk, The Netherlands.
Wim E
WE
Tuinebreijer
Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, The Netherlands.
Marianne K
MK
Nieuwenhuis
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.
Esther
E
Middelkoop
Association of Dutch Burn Centers, Burn Center Maasstad Hospital, Rotterdam, The Netherlands.
Margriet E
ME
van Baar
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002056:Burns / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology*; D003116:Color; D004548:Elasticity / Q000502:physiology; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012879:Skin Physiological Phenomena; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult