Pressure therapy for post-burn scars: does it work?

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The effects of conservative treatments on burn scars: a systematic review

A variety of conservative treatments for burn scars are available, but there is no clear consensus on the evidence. The purpose of this study was to summarize the available literature on the effects of conservative treatments of burn scars in adults. RCTs and CCTs were sought in three databases, reference lists of retrieved articles and relevant reviews. The Scottish Intercollegiate Guidelines Network scoring system was used to assess the quality of the selected studies. Information on the study characteristics, results and interventions was extracted. Twenty-two articles were included into the review and categorized in six topics: 5 on massage therapy, 4 on pressure therapy, 6 on silicone gel application, 3 on combined therapy of pressure and silicone, 3 on hydration and 1 on ultrasound. Pressure and silicone therapy are evidence-based conservative treatments of hypertrophic scar formation after a burn producing clinically relevant improvement of scar thickness, redness and pliability. Massage therapy could have a positive result on scar pliability, pain and pruritus, but with less supporting evidence. The use of moisturizers and lotions could have an effect on itching, but the findings are contradictory. Of all other non-invasive treatments such as splinting, casting, physical activity, exercise and mobilizations no RCTs or CCTs were found.publisher: Elsevier articletitle: The effects of conservative treatments on burn scars: A systematic review journaltitle: Burns articlelink: http://dx.doi.org/10.1016/j.burns.2015.12.006 content_type: article copyright: © 2015 Elsevier Ltd and ISBI. All rights reserved.status: publishe

A comparison between laser-doppler imaging and colorimetry in the assessment of scarring:a pilot study

BACKGROUND: This cross-sectional pilot-study investigated the reproducibility of the LDI (Moor-LDI-B2; Moor Instruments) and the chromameter (Minolta chromameter CR-300) when used in scar assessment. METHODS: Twenty-seven scars in 14 subjects were included between January and June 2003. One observer performed two times both measurements with 10 min apart. The intra-observer agreement is quantified by means of the intra-class correlations (ICC) and the standard errors of measurement (SEM) for both the LDI and the chromameter. RESULTS: Ignoring one outlier, the ICC of the LDI = 0.856 and the SEM = 34.56. The chromameter shows a better reproducibility with an ICC of 0.93 and a SEM of 0.79. CONCLUSION: This pilot-study with a limited number of measurements shows a moderate reproducibility of the LDI compared to the chromameter measurements, in the assessment of respectively flux and redness in scars.Dr. Wouter Peeters is a PhD student that I am co-promotor of at the Department of Plastic Surgery, Academical Hospital Maastricht, The Netherlands.status: publishe

A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study

Background: Since the management of keloid and hypertrophic scars still remains a difficult clinical problem, there is need for adequate, effective therapy. In this study, we explored for the first time the efficacy and the potential synergetic effect of combined triamcinolone and verapamil for the treatment of hypertrophic and keloid scars. The objective was to assess the efficacy of combined intralesional triamcinolone and verapamil therapy for hypertrophic and keloid scars. Methods: Fifty-eight patients with hypertrophic scars (n = 31) and keloid scars (n = 27) were included. A specific injection therapy scheme was applied. Five follow-up moments were chosen, with a maximum follow-up of nearly 2 years. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and pruritus were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). Results: Our results reveal a fast and abiding improvement of both keloid and hypertrophic scars after treatment with the combination therapy. All POSAS components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly (P 12 months after start of therapy in both keloids and hypertrophic scars. Conclusions: This study reveals that combined therapy of triamcinolone and verapamil results in overall significant scar improvement with a long-term stable result.Level of evidence: Level IV, therapeutic study.status: publishe

Duration of Scar Maturation:Retrospective Analyses of 361 Hypertrophic Scars Over 5 Years

OBJECTIVE: Maturation remains the least understood phase of wound healing; estimates of maturation time are broad and inaccurate. A more precise estimation of maturation time could influence scar therapy and give insight to the wound healing cascade. The objective of this study was to assess the mean time between onset and complete maturation of hypertrophic scars. METHODS: This retrospective study was performed in an outpatient clinic of the Maastricht University Medical Center exclusively focused on scar treatment; 361 patients with a hypertrophic scar were included between September 2010 and December 2015. MAIN OUTCOME MEASURES: Date of onset and date of complete maturation were documented in patients' medical files. Patients were divided into three patient groups: 55 years. Different scar causes and scar therapies were analyzed in relation to maturation time. MAIN RESULTS: These results reveal statistically significant differences (P 55 patients (22.53 months) and between >55 and 30-55 year old patients (34.64 months). Significant differences in mean maturation time were also found between scars treated with pressure therapy (23.20 months) and combination therapy (30.59 months), silicone therapy (35.51 months), injection therapy (46.43 months), and other therapies (41.31 months). No significant differences in maturation time were found relative to scar cause. CONCLUSIONS: This study shows that hypertrophic scars take significantly more time to completely maturate than previously believed, and older patients show the fastest healing. Further, scars treated with pressure therapy maturate fastest.status: publishe

Three dimensional imaging for volume measurement of hypertrophic and keloid scars, reliability of previously validated simplified technique in clinical setting

INTRODUCTION: Evidence behind many of the current treatments in hypertrophic and keloid scars remains limited. Current objective methods to assess efficacy and provide follow-up can be complex and are not easily applied in clinical setting. The aim of this study was to assess reliability of a recently validated simplified technique for volume measurement in clinical practice. METHODS: Volume measurement of 28 hypertrophic and keloid scars was conducted in 22 consecutive patients, using a three-dimensional stereophotogrammetry. Intra- and inter-rater reliability was assessed by the intraclass correlation coefficient (ICC) and the coefficient of variation (CV). The measurement error was expressed as limits of agreement (LoA). RESULTS: The simplified method for three-dimensional volume measurement showed good intra-rater reliability with an ICC of 0.997 and a CV of 7.3%, and a good inter-rater reliability with an ICC of 0.999 and a CV of 5.7%. The plot of the differences and LoA showed near-perfect agreement between observers. CONCLUSION: Objective evaluation of scar volume using the simplified three-dimensional measurement technique may complement subjective scoring and improve the ability to quantitatively compare the response to therapeutic methods.status: publishe

Measurement of elasticity and transepidermal water loss rate of burn scars with the Dermalab(®)

This cross-sectional study investigated the reproducibility of repeated elasticity and transepidermal water loss (TEWL) measurements with the DermaLab(®) on 32 active burn scars and healthy skin. Intra- and inter-observer reproducibility was examined by means of intra-class correlation coefficients (ICC) and standard error of measurements (SEM). Results showed good ICC values and rather high SEM values for inter- and intra-observer reproducibility of elasticity measurements. For TEWL measurements, ICC values were good and SEM values were high for inter- and intra-observer reproducibility. There was a significant difference between the estimated mean elasticity values of normal skin and grafted scars and between normal skin and spontaneously healed scars (p≤0.003). For the estimated mean TEWL values, there was a significant difference between normal skin and spontaneously healed scars (p=0.036). A significant negative relation was reported between mean TEWL and time after burn (p=0.008). In clinical trials it is necessary to interpret patient-specific changes in elasticity and TEWL with caution, since the SEMs of both modes are rather high. We therefore recommend the use of a mean of repeated measurements of elasticity and TEWL to decrease the SEM.status: publishe