Abstract
Various treatment modalities, such as surgical treatment and conservative treatment, including steroid injection, silicone gel sheeting, pressure treatment, and laser treatment, are available for treating scars. Assessment of the treatment outcome is crucial for determining appropriate treatment modality. In this chapter, we introduce assessment tools for scars. First, we address subjective assessment using scar rating scales in chronological order. The rating scales assess the main features of scars. They are simple, easy to use, noninvasive, fast, and inexpensive. Therefore, they are suitable for use in clinical practice. Second, we address objective assessment using devices for the measurement of scars. We categorize the devices according to the clinical scar features, namely color, thickness, pliability, surface area, and volume. The objective assessment of scars is quantitative, accurate, reliable, reproducible, and valid. Thus, the devices can detect small improvements. However, a small improvement in the treatment outcome may not meet the expectations of patients. Nevertheless, assessment of the outcome using devices is appropriate for research purposes.
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References
Smith GM, Tompkins DM, Bigelow ME, et al. Burn-induced cosmetic disfigurement: can it be measured reliably? J Burn Care Rehabil. 1988;9(4):371–5.
Crowe JM, Simpson K, Johnson W, et al. Reliability of photographic analysis in determining change in scar appearance. J Burn Care Rehabil. 1998;19(2):183–6.
Sullivan T, Smith J, Kermode J, et al. Rating the burn scar. J Burn Care Rehabil. 1990;11(3):256–60.
Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16(5):535–8.
Nedelec B, Shankowsky HA, Tredget EE. Rating the resolving hypertrophic scar: comparison of the Vancouver Scar Scale and scar volume. J Burn Care Rehabil. 2000;21(3):205–12.
Forbes-Duchart L, Mrashall S, Strock A, et al. Determination of inter-rater reliability in pediatric burn scar assessment using a modified version of the Vancouver Scar Scale. J Burn Care Res. 2007;28(3):460–7.
Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004b;113(7):1960–5. discussion 1966–1967.
Yeong EK, Mann R, Engrav LH, et al. Improved burn scar assessment with use of a new scar-rating scale. J Burn Care Rehabil. 1997;18(4):353–5. discussion 352.
Beausang E, Floyd H, Dunn KW, et al. A new quantitative scale for clinical scar assessment. Plast Reconstr Surg. 1998;102(6):1954–61.
Quinn JV, Drzewiecki AE, Stiell IG, et al. Appearance scales to measure cosmetic outcomes of healed lacerations. Am J Emerg Med. 1995;13(2):229–31. https://doi.org/10.1016/0735-6757(95)90100-0.
Moiemen NS, Staiano JJ, Ojeh NO, et al. Reconstructive surgery with a dermal regeneration template: clinical and histologic study. Plast Reconstr Surg. 2001;108(1):93–103.
Masters M, McMahon M, Svens B. Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS). J Burn Care Rehabil. 2005;26(3):273–84.
Martin D, Umraw N, Gomez M, et al. Changes in subjective vs objective burn scar assessment over time: does the patient agree with what we think? J Burn Care Rehabil. 2003;24(4):239–44. discussion 238. https://doi.org/10.1097/01.BCR.0000075842.55039.03.
Singer AJ, Arora B, Dagum A, et al. Development and validation of a novel scar evaluation scale. Plast Reconstr Surg. 2007;120(7):1892–7. https://doi.org/10.1097/01.prs.0000287275.15511.10.
Bae SH, Bae YC. Analysis of frequency of use of different scar assessment scales based on the scar condition and treatment method. Arch Plast Surg. 2014;41(2):111–5. https://doi.org/10.5999/aps.2014.41.2.111.
Schneider JC, Holavanahalli R, Helm P, et al. Contractures in burn injury: defining the problem. J Burn Care Res. 2006;27(4):508–14. https://doi.org/10.1097/01.BCR.0000225994.75744.9D.
Schneider JC, Holavanahalli R, Helm P, et al. Contractures in burn injury part II: investigating joints of the hand. J Burn Care Res. 2008;29(4):606–13. https://doi.org/10.1097/BCR.0b013e31817db8e1.
Fearmonti R, Bond J, Erdmann D, et al. A review of scar scales and scar measuring devices. Eplasty. 2010;10:e43.
Yamawaki S, Naitoh M, Ishiko T, et al. Keloids can be forced into remission with surgical excision and radiation, followed by adjuvant therapy. Ann Plast Surg. 2011;67(4):402–6. https://doi.org/10.1097/SAP.0b013e31820d684d.
Ogawa R, Akaishi S. Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis—keloids and hypertrophic scars may be vascular disorders. Med Hypotheses. 2016;96:51–60. https://doi.org/10.1016/j.mehy.2016.09.024.
Tyack Z, Simons M, Spinks A, et al. A systematic review of the quality of burn scar rating scales for clinical and research use. Burns. 2012;38(1):6–18. https://doi.org/10.1016/j.burns.2011.09.021.
Draaijers LJ, Botman YA, Tempelman FR, et al. Skin elasticity meter or subjective evaluation in scars: a reliability assessment. Burns. 2004a;30(2):109–14. https://doi.org/10.1016/j.burns.2003.09.003.
Oliveira GV, Chinkes D, Mitchell C, et al. Objective assessment of burn scar vascularity, erythema, pliability, thickness, and planimetry. Dermatol Surg. 2005;31(1):48–58.
Nedelec B, Correa JA, Rachelska G, et al. Quantitative measurement of hypertrophic scar: intrarater reliability, sensitivity, and specificity. J Burn Care Res. 2008b;29(3):489–500. https://doi.org/10.1097/BCR.0b013e3181710869.
Atiles L, Mileski W, Purdue G, et al. Laser Doppler flowmetry in burn wounds. J Burn Care Rehabil. 1995;16(4):388–93.
Ehrlich HP, Kelley SF. Hypertrophic scar: an interruption in the remodeling of repair—a laser Doppler blood flow study. Plast Reconstr Surg. 1992;90(6):993–8.
Perry DM, McGrouther DA, Bayat A. Current tools for noninvasive objective assessment of skin scars. Plast Reconstr Surg. 2010;126(3):912–23. https://doi.org/10.1097/PRS.0b013e3181e6046b.
Merz KM, Pfau M, Blumenstock G, et al. Cutaneous microcirculatory assessment of the burn wound is associated with depth of injury and predicts healing time. Burns. 2010;36(4):477–82. https://doi.org/10.1016/j.burns.2009.06.195.
Verhaegen PD, van der Wal MB, Middelkoop E, et al. Objective scar assessment tools: a clinimetric appraisal. Plast Reconstr Surg. 2011;127(4):1561–70. https://doi.org/10.1097/PRS.0b013e31820a641a.
Fong SS, Hung LK, Cheng JC. The cutometer and ultrasonography in the assessment of postburn hypertrophic scar—a preliminary study. Burns. 1997;23(Suppl 1):S12–8.
Katz SM, Frank DH, Leopold GR, et al. Objective measurement of hypertrophic burn scar: a preliminary study of tonometry and ultrasonography. Ann Plast Surg. 1985;14(2):121–7.
Nedelec B, Correa JA, Rachelska G, et al. Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity. J Burn Care Res. 2008a;29(3):501–11. https://doi.org/10.1097/BCR.0b013e3181710881.
Aya R, Yamawaki S, Muneuchi G, et al. Ultrasound elastography to evaluate keloids. Plast Reconstr Surg Glob Open. 2014;2(2):e106. https://doi.org/10.1097/GOX.0000000000000048.
Aya R, Yamawaki S, Yoshikawa K, et al. The shear wave velocity on elastography correlates with the clinical symptoms and histopathological features of keloids. Plast Reconstr Surg Glob Open. 2015;3(7):e464. https://doi.org/10.1097/GOX.0000000000000445.
Esposito G, Ziccardi P, Scioli M, et al. The use of a modified tonometer in burn scar therapy. J Burn Care Rehabil. 1990;11(1):86–90.
Falanga V, Bucalo B. Use of a durometer to assess skin hardness. J Am Acad Dermatol. 1993;29(1):47–51.
van Zuijlen PP, Angeles AP, Kreis RW, et al. Scar assessment tools: implications for current research. Plast Reconstr Surg. 2002;109(3):1108–22.
Lee KC, Dretzke J, Grover L, et al. A systematic review of objective burn scar measurements. Burns Trauma. 2016;4:14. https://doi.org/10.1186/s41038-016-0036-x.
Matsuzaki K, Kumagai N, Fukushi S, et al. Cultured epithelial autografting on meshed skin graft scars: evaluation of skin elasticity. J Burn Care Rehabil. 1995;16(5):496–502.
Rennekampff HO, Rabbels J, Reinhard V, et al. Comparing the Vancouver Scar Scale with the cutometer in the assessment of donor site wounds treated with various dressings in a randomized trial. J Burn Care Res. 2006;27(3):345–51. https://doi.org/10.1097/01.BCR.0000216311.61266.00.
van Zuijlen PP, Vloemans JF, van Trier AJ, et al. Dermal substitution in acute burns and reconstructive surgery: a subjective and objective long-term follow-up. Plast Reconstr Surg. 2001;108(7):1938–46.
van Zuijlen PP, Angeles AP, Suijker MH, et al. Reliability and accuracy of techniques for surface area measurements of wounds and scars. Int J Low Extrem Wounds. 2004;3(1):7–11. https://doi.org/10.1177/1534734604263200.
Ahn ST, Monafo WW, Mustoe TA. Topical silicone gel for the prevention and treatment of hypertrophic scar. Arch Surg. 1991;126(4):499–504.
Sawada Y. A method of recording and objective assessment of hypertrophic burn scars. Burns. 1994;20(1):76–8.
Ardehali B, Nouraei SA, Van Dam H, et al. Objective assessment of keloid scars with three-dimensional imaging: quantifying response to intralesional steroid therapy. Plast Reconstr Surg. 2007;119(2):556–61. https://doi.org/10.1097/01.prs.0000252505.52821.76.
Taylor B, McGrouther DA, Bayat A. Use of a non-contact 3D digitiser to measure the volume of keloid scars: a useful tool for scar assessment. J Plast Reconstr Aesthet Surg. 2007;60(1):87–94. https://doi.org/10.1016/j.bjps.2005.12.051.
van der Aa T, Verhiel SH, Erends M, et al. A simplified three-dimensional volume measurement technique in keloid scars: Validity and reliability. J Plast Reconstr Aesthet Surg. 2015;68(11):1574–80. https://doi.org/10.1016/j.bjps.2015.07.001.
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Yamawaki, S. (2020). Scar Evaluation. In: Ogawa, R. (eds) Total Scar Management. Springer, Singapore. https://doi.org/10.1007/978-981-32-9791-3_6
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DOI: https://doi.org/10.1007/978-981-32-9791-3_6
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