Assessing quality of healing in skin: Review of available methods and devices

Abstract

The process of wound healing is dynamic and takes place over months to years, during which there is a resolution of angiogenesis, continued wound contraction, and connective tissue remodeling. The outcome of this process is most commonly the formation of a scar, defined as a fibrous tissue replacing normal tissues destroyed by injury or disease. Scars often have a lowered or total loss of vital skin functions and imbue a large burden on both the patient and the health care system as a whole. Scar treatments are plentiful but are often unsatisfactory or inconsistent. No single treatment method has been universally adopted. To evaluate the clinical treatment as well as research focused on developing novel methods for scar management, objective studies of the progression of scar formation and the properties of mature scars are needed. Several parameters, including barrier function as well as mechanical and physiological properties, need to be taken into account when both categorizing and treating healing wounds and scars. To date, there is no available methodology that provides a comprehensive evaluation of a scar's properties. This review aims at presenting an overview of available scar assessment methods and devices, ranging from analysis of collagen properties in tissue biopsies to noninvasive methods for studies of mechanical parameters such as breaking strength and skin elasticity. In the cases where conclusive studies have been performed, the differences between normal skin and scar with respect to the above parameters are presented. Furthermore, this review highlights areas where the development of additional modalities are needed.

Current progress in understanding the molecular pathogenesis of burn scar contracture

“…The molecular basis/pathogenesis of scar contracture is complicated and includes cellular factors and environmental contributions. No single treatment method has been demonstrated to be effective [60]. To find the appropriate treatment for scar contractures, we prefer to consider a comprehensive strategy, including cytokines and environmental aspects, and then translate the basic discoveries into potential therapies.…”

Non‐invasive objective devices for monitoring the inflammatory, proliferative and remodelling phases of cutaneous wound healing and skin scarring

“…When used on tissue, moving blood cells introduce dynamic changes to the speckle pattern. Both laser Doppler imaging and speckle imaging quantify perfusion; however, Doppler imaging provides quantitative data, while speckle imaging enables only qualitative data . These devices enable the simplicity of use and provide accurate high temporal resolution images .…”

“…Another objective method proposed to assess wound re‐epithelialisation is analysis of the restoration of the barrier function of the skin by measuring the water vapour transmission . The skin barrier function is mainly assigned to the stratum corneum layer of the epidermis, which prevents exogenous substances entering the body and minimises the transepidermal water loss (TEWL) . The quantity of water vapour lost, either by active transport or by passive diffusion, can be measured directly by the TEWL .…”

Post-surgical scar assessment in rehabilitation: a systematic review

“…In the literature many reviews on validated tools-devices and rating scales-for scar assessment have been published [1,3,10,12,13], but to our best knowledge there are none specifically analyzing those used for post-surgical scar assessment in the rehabilitation setting. The aim of this focused review was thus to illustrate the tools-instruments, scales and questionnaires-validated to assess post-surgical scar pliability for use in rehabilitation.…”

“…Early identification of a pathological post-surgical scar is crucial in order to start treatment promptly so as to obtain an optimal outcome. Scar assessment tools provide data on objective parameters so that treatment can be planned accordingly [10]. The demonstration of sound psychometric properties in these measures (validation) is essential so that clinicians know they Physical Therapy and Rehabilitation can rely on data as an accurate and meaningful indicator of the treatment outcome, and thus a key factor in improving decision making in clinical practice [11].…”