BackgroundIt 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.MethodsWe 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.ResultsOverall 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.ConclusionsThe 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 registrationNot applicable.

A child with a burn injury often has to go through reconstructive surgery after it has healed to improve function and cosmetic appearance. Tissue expansion is one of the procedures commonly used in the reconstructive process. It requires commitment from the child and the family, because it involves several hospital visits, including at least two surgical episodes, in addition to a change in lifestyle during the process, and there are time and costs involved in travelling, including time off work and school. However, most families think that the final improvement achieved is worthwhile. Multidisciplinary pre-reconstruction clinics offer information and individualised support on the clinical, practical and psychological aspects of the procedures. The audit presented in this article found that attendance at the clinics can improve patient education, reduce complications and enhance the experience of the children and their families.