Abstract
BackgroundSkin grafting is the current gold standard for treatment of deeper burns. How patients appraise the donor-site scar is poorly investigated. The aim of this study was to evaluate long-term patient-reported quality of donor-site scars after split skin grafting and identify possible predictors. MethodsA prospective cohort study was conducted. Patients were included in a Dutch burn centre during one year. Patient-reported quality of donor-site scars and their worst burn scar was assessed at 12 months using the Patient and Observer Scar Assessment Scale (POSAS). Mixed model analyses were used to identify predictors of scar quality. ResultsThis study included 115 donor-site scars of 72 patients with a mean TBSA burned of 11.2%. The vast majority of the donor-site scars (84.4%) were rated as having at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and the overall opinion on 80.9% of the donor-site scars was that they deviated from normal skin 12 months after surgery. The overall opinion on the donor-site scar was 3.2 ± 2.1 vs. 5.1 ± 2.4 on the burn scar. A younger age, female gender, a darker skin type, and location on the lower leg were predictors of reduced donor-site scar quality. In addition, time to re-epithelization was associated with scar quality. ConclusionThis study provided new insights in long-term scar quality of donor-sites. Donor-site scars differed from normal skin in a large part of the population 12 months after surgery. Results of this study can be used to inform patients on the long-term outcomes of their scars and to tailor preventive or therapeutic treatment options.
Highlights
Skin grafting is the current gold standard for treatment of deeper burns
Donor-sites that remain after skin grafting form scars, which may heal aesthetically displeasing with noticeable depigmentation and hypertrophy [4À6]
The patient part of the Patient and Observer Scar Assessment Scale (POSAS) version 2.0 was used to assess the scar quality of their donor sites and of the burn scar that they indicated as most severe
Summary
Skin grafting is the current gold standard for treatment of deeper burns. How patients appraise the donor-site scar is poorly investigated. The aim of this study was to evaluate long-term patient-reported quality of donor-site scars after split skin grafting and identify possible predictors. Results: This study included 115 donor-site scars of 72 patients with a mean TBSA burned of 11.2%. Conclusion: This study provided new insights in long-term scar quality of donor-sites. Results of this study can be used to inform patients on the long-term outcomes of their scars and to tailor preventive or therapeutic treatment options. In present day burn care, excision and skin grafting is the cornerstone in the treatment of deeper burns to facilitate wound healing and provide a good functional and aesthetic scar outcome [1À3]. Scar quality is one of the most important outcomes in burn surgery today, there is no evidence to support therapeutic decision-making regarding skin grafting and expected donorsite morbidity. When treating smaller injuries, other treatment options might be considered if significant distress for the patient is expected after surgery
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