Burn Therapists’ Opinion on the Application and Essential Characteristics of a Burn Scar Outcome Measure

Abstract

Comprehensive burn rehabilitation requires the use of an appropriate burn scar outcome measure (BSOM). The literature reports many BSOMs; however, an objective, practical, inexpensive, valid, reliable, and responsive instrument eludes us. A problem in the development of such a measure is disagreement in which scar properties to include. The objective of this study was to determine the burn scar variables that therapists believe should be included in a BSOM. An Internet survey was administered to burn occupational and physical therapists. The response rate was 38.6% (105 surveys). Of the respondents, 38.1% use a BSOM; of those, 75% use the Vancouver Scar Scale. Reasons why respondents do not use a BSOM (61.9%) are because they are not familiar with available measures, have not found one that is clinically practical, or need more training. The majority (95%) believes that using a BSOM is important, and the following BSOM characteristics were reported as important: reliable, valid, quick, easy, and noninvasive. Respondents indicated that the following properties should be included in a BSOM: pliability (96.2%), vascularity (92.4%), height (87.6%), appearance (75.2%), skin breakdown (74.3%), itch (73.3%), surface texture (70.5%), pigmentation (68.6%), and pain (67.6%). This study suggests that using a BSOM is important despite its inconsistent use, and BSOM education may be valuable. The top three agreed-upon properties for inclusion are already incorporated into the most commonly used BSOM-the Vancouver Scar Scale-suggesting that modifications may be reasonable.

Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

“…Hypertrophic scars might be itchy and painful and cause serious functional and cosmetic disability in many burn survivors; almost all burn patients thus complain about the appearance of their scars and suffer from cacesthesia such as itching or pruritus and pain. A previous study reported that the most common and distressful complications of burn patients were abnormal appearance (75.2%), itching (73.3%), and pain (67.6%)14. Itching in the hypertrophic scar continues to be a major obstacle in the rehabilitation of severe burn patients.…”

Update on hypertrophic scar treatment

“…A previous study reported that the most common and distressing complications in burn patients who developed HTSs were abnormal appearance (75.2%), pruritus (73.3%) and pain (67.6%) (45). The cause of pruritus in HTSs and keloid scars is not yet well characterized, but recent studies have indicated the probable involvement of direct activation of opioid receptors identified in the skin (46).…”

New advances in widespread/burn scar management

“…Burn therapists' analysis of burn patient symptomatology revealed that the most common and distressful complications in burn patients were abnormal appearance (75.2%), itch (73.3%) and pain (67.6%) [11]. Itching usually begins at the time of wound closure with maximal intensity at three months often continuing over a year or more with significant impairment of quality of life.…”

“…Scar tissue collagen and ECM ground substance is influenced by external vector forces that impact on collagen bundle size and directionality [11,16]. By controlling the biomechanics of the wound environment, new design dressings will have the capacity to improve healing and reduce scar formation [11,15,[17][18][19].…”