A systematic review of objective burn scar measurements

BackgroundProblematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies.MethodsA systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured.The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost.ResultsAfter duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances.ConclusionsObjective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability

Use of high frequency ultrasound to detect changes in skin integrity: An image evaluation validation procedure

OBJECTIVES: High frequency ultrasound scanning may be used for prevention, detection and monitoring of pressure ulcers in patients at risk and is amenable for portable, bedside use by a variety of clinicians. Limited data are available about the criteria to determine an ideal image or measures of tissue changes representative of tissue injury. We developed and evaluated criteria for overall image quality and measures of tissue integrity. METHODS: In 40 mechanically ventilated adults in 3 ICUs, 241 HFUS sacral images were evaluated for agreement using criteria for overall image quality and tissue changes (dermal, hypodermal layer thickness and layer density). RESULTS: HFUS sacral images (N= 241) were evaluated in three analyses and showed poor agreement in all three analyses using the specific criteria for global quality, however when criteria were collapsed agreement was good to substantial. Evaluator agreement for layer thickness and layer density was also good. CONCLUSIONS: A global rating is adequate for identifying good images. Agreement for measurements of layer thickness and density were also good and may be useful to identify early changes in tissue integrity leading to tissue injury. Additional data are needed concerning the association of changes in layer thickness and layer density to eventual tissue injury