Measurement Of Scar Thickness Research Articles

Clinical Utility of Extracorporeal Shock Wave Therapy on Hypertrophic Scars of the Hand Caused by Burn Injury: A Prospective, Randomized, Double-Blinded Study.

Postburn hypertrophic scarring is a common complication in burn injuries to the hands, often associated with impaired hand function. We evaluated the effects of extracorporeal shock wave therapy (ESWT), compared to a sham stimulation therapy, on hypertrophic scars of the hand caused by burn injury and investigated its effects on hand function. This was a double-blinded, randomized, controlled trial of 48 patients with a burn to their dominant right hand. The parameters of ESWT were as follows: energy flux density, 0.05–0.30 mJ/mm2; frequency, 4 Hz; 1000 to 2000 impulses per treatment; four treatments, once a week for four weeks. The outcomes measured were as follows: a 10-point visual analogue scale pain score; Vancouver scar scale for scar vascularity, height, pliability and pigmentation; ultrasound measurement of scar thickness; Jebsen−Taylor hand function test; grip strength; Perdue pegboard test; and the Michigan hand outcomes questionnaire. The change in the score from baseline to post-treatment was compared between the two groups. ESWT improved the pain score (p = 0.001), scar thickness (p = 0.018), scar vascularity (p = 0.0015), and improved hand function (simulated card-turning, p = 0.02; picking up small objects, p = 0.004). The other measured outcomes were not different between the two groups. ESWT is effective in decreasing pain, suppressing hypertrophic scarring, and improving hand function.

Focused versus radial extracorporeal shock wave therapy in post burn hypertrophic scar: A single blinded randomized controlled trial

Purpose. Hypertrophic scar (HTS) is one of the common post-burn complications that lead to functional and cosmetic impairments, so we pursued to examine efficacy of extracorporeal shock wave therapy (ESWT) on HTS in expression of improving scar thickness and appearance. Materials and Methods. 60 patients with post burn HTS were recruited in this trial and divided randomly into 3 equal groups. Group A: received focus ESWT (100 shock waves per cm2, 0.037 mJ/mm2, 4 Hz, 2 times/week for six weeks) plus traditional topical medication (MEBO Scaro cream). Group B: received radial ESWT (500 shock waves per cm2, 0.13 mJ/mm2, 6 Hz, 2 times/week for six weeks) plus MEBO Scaro cream. Group: received only MEBO Scaro cream. Ultrasonography was utilized for scar thickness measurement and scar characteristics assessment was done by Modified Vancouver Scar Scale (MVSS). All measures were gathered before the start of the study, and after termination of the trial (after 6 weeks). Results. Both focus and radial ESWT showed significant advance in scar thickness and MVSS post treatment (p > 0.001), without statistical differences between them (p > 0.05), while group C showed only a significant diminution in MVSS post treatment (p > 0.001), without any change in scar thickness. Conclusion. Higher statistical results were achieved with both focus and radial ESWT without any side effects, confirming the safety and efficiency of ESWT in HTS management.

Comparative accuracy of magnetic resonance morphometry and sonography in assessment of post-cesarean uterine scar.

Objective:To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with that of ultrasonography (USG) for the measurement of lower segment cesarean scar during trial of labor after cesarean (TOLAC).Materials and Methods:This was a prospective case-control observational study conducted with a cohort of 30 participants being considered for TOLAC but eventually proceeding to lower segment cesarean section (LSCS) at a university-based teaching institute over a period of 2 years. Measurement of scar thicknesses were done by MRI and USG preoperatively and validated by surgical findings. Comparison of diagnostic accuracy as well as the cut-off values (to differentiate a normal scar from an abnormal scar) was done between the two modalities.Results:Insignificant systematic error between the measurements obtained by the two modalities was noted by a Bland–Altmann analysis. The diagnostic accuracy of USG for differentiating a normal from an abnormal uterine scar was 96.7% while that of MRI was at a slightly lower level of 90%. A strong level of agreement between the two modalities was observed.Conclusion:MRI offers no advantage in diagnostic accuracy for the measurement of LSCS scar thickness during consideration of TOLAC.Advances in Knowledge:Measurement of uterine scar by MRI has a good correlation with that done on USG in the setting of post-cesarean pregnancy. The results hold good both for normal (grades 1 and 2) and abnormal (grades 3) scars. MRI, however, does not offer any added advantage over sonographic scar thickness measurement for the differentiation of a normal (grades 1 and 2) from an abnormal (grade 3) scar.

Scar thickness measurement by transvaginal sonography in late second trimester and third trimester in pregnant patients with previous cesarean section: does sequential change in scar thickness with gestational age correlate with mode of delivery?

The objective of this study was to evaluate whether scar thickness measured by transvaginal sonography and the sequential change in scar thickness from second to third trimester has any association with mode of delivery in patients with previous cesarean. Pregnant women with previous one cesarean section underwent transvaginal sonography between 24 and 28weeks of gestation and then a repeat scan beyond 36weeks of gestation to measure scar thickness. These scar thickness measurements were then correlated with the mode of delivery. The scar was measured at multiple sites (3-4) of the lower uterine segment and its thinnest portion was considered to be the scar. Scar thickness was thinner in those patients having cesarean delivery than those having vaginal delivery and this difference was statistically significant at both the gestational ages. Mean scar thickness at 24-28weeks of gestation in patients who delivered vaginally is 4.8±1.1mm and in those who had repeat cesarean section is 4.4±1.1mm (p value=0.043). Mean scar thickness beyond 36weeks of gestation in patients who delivered vaginally is 3.3±0.7mm and in those who had repeat cesarean section is 2.9±0.9mm (p value=0.003). The mean decrease in scar thickness was not significantly different between those who delivered vaginally (mean decrease=1.73±0.95mm) and those who had a repeat cesarean (mean decrease=1.91±0.96mm). Our study concluded that thicker scars are associated with better chances of successful vaginal birth after cesarean. Measurement at both late second trimester and third trimester can be done but latter has better correlation with mode of delivery. This association may be explained by the fact that thinner scars have more chances of fetal bradycardia, meconium staining of liquor and previous cesarean for feto-pelvic disproportion.

Comparison of scar thickness measurements using trans-vaginal sonography and MRI in cases of pregnancy with previous caesarean section. Do they correlate with actual scar thickness?

The aim of this study was to evaluate scar thickness in cases of pregnancy with previous caesarean section, by trans-vaginal sonography (TVS) and magnetic resonance imaging (MRI), and to correlate precision of radiologically-measured scar thickness with actual measurement of scar thickness. A total of 35 pregnant patients with previous caesarean section planned for elective caesarean section, were evaluated prospectively. Their scar thickness was measured by TVS and MRI on the day of elective repeat caesarean section. These measurements were correlated with each other and with scar thickness measured during elective repeat caesarean section by using a caliper. The correlation coefficients between scar thickness measured by TVS and MRI with peroperative evaluation with a caliper, were +0.72 and +0.59, respectively. The study concluded that as MRI is a costlier modality and TVS has better correlation coefficient with actual scar thickness, TVS can be considered to be the better modality for antenatal scar thickness measurement.

Preliminary research on the relationship between inhibitory effect of triamcinolone acetonide on hypertrophic scar and oxygen free radicals in rabbits

To investigate the relationship between inhibitory effect of triamcinolone acetonide(TA) on hypertrophic scar and oxygen free radicals in rabbits. 18 New Zealand rabbits were used. 14 rabbits were selected randomly to construct animal models of hypertrophic scar on the ears. Another 4 rabbits (8 ears) were used as controls. 6 weeks after operation, the hypertrophic scar on the ears were randomly divided to receive intra-lesion injection of TA (n=10), or normal saline (n=10), or nothing (n=8, sham group). 9 weeks after operation, scar specimens were taken for scar thickness measurement, fibroblast counting under microscopy and MDA content detection by spectrophotometric method. (1) 3 weeks after TA treatment, the scar became very thin and soft with a similar color to normal skin and a smooth surface; (2) Histologic study showed the collagen fibers in TA group were reduced markedly and arranged parallelly; (3) Compared with normal skin, the fibroblast density in sham and saline groups increased significantly (P < 0.05), while it was not markedly different in TA group (P > 0.05). There was also no significant difference in scar hypertrophic index between sham and saline groups (P > 0.05), but the scar hypertrophic index was decreased dramatically in TA group (P < 0.05); (4) The MDA content was highest in TA group (P < 0.05), followed by that in sham and saline groups (P < 0.05), while there was no difference between these two groups (P > 0.05). It was lowest in normal control group (P < 0.05). The oxygen free radicals in the hypertrophic scar can be further increased by local injection of TA.

Application of tissue ultrasound palpation system (TUPS) in objective scar evaluation

One of the characteristics of hypertrophic scarring is its raised appearance. Its maturation often results in increased thickness. Therapists usually rely on subjective observation and palpation to document scar thickness. The result of these subjective assessments may reflect only the superficial scar thickness but is unable to measure the whole scar volume and thickness under the skin surface. Measurement of scar thickness using ultrasound imaging has been previously reported, but has not been commonly used in clinics due to its complex operation method and high cost. In this study, we have adopted a newly developed and user-friendly Tissue ultrasound palpation system (TUPS) for the assessment of scar thickness. It consists of a finger size palpation probe, connected to an ultrasound transducer and an in-series load cell to measure the thickness of the soft tissue over the human body. The method of operation is easy and it can be used to measure skin thickness on various parts of the body, thus reflecting the skin thickness. The reliability of the TUPS in clinical application was tested on 30 subjects with a hypertrophic scar at a local hospital. Three raters implemented two assessments on each subject to study its test-retest and inter-rater reliabilities. It was then used to assess 100 subjects with various severity of hypertrophic scar caused by trauma, scald, burn or surgery. They were assessed using TUPS as well as the Vancouver Scar Scale (VSS) for rating scar thickness, pliability, pigmentation and vascularity. Two-way mixed intra-class correlation showed a high test-retest reliability with Intraclass Correlation Coefficient (ICC) = 0.98 and inter-rater reliability ICC = 0.84. Fair positive correlations with VSS thickness score and VSS total score r = 0.34 ( p < 0.05) and 0.42 ( p < 0.05), respectively. A significant difference between two scar type groups (50 burn scald scars and 50 surgical scars) was demonstrated (d.f. = 52.94, t = 3.99, p < 0.01). TUPS was proved to have high inter-rater, test-retest reliability and it had a moderate correlation with the VSS that clinicians used for assessment of the scar. This system is recommended for clinical assessment of scar thickness.

Ultrasound assessment of scald scars in Asian children receiving pressure garment therapy

Background/Purpose: Scar formation after scald injury in children is managed commonly by application of pressure garment. The duration of the treatment depends on clinical assessment. The objective of the study was to evaluate the efficacy of the pressure garment therapy and to correlate the clinical assessment scar thickness with ultrasound measurement. Methods: Prospective study of children with hypertrophic scars receiving pressure garment therapy was carried out between 1993 and 1998. The scars were mapped with paper cutting. Representative scar sites were scored clinically according to Vancouver General Hospital Burn Assessment Scale (pigmentation, vascularity, pliability, height, pain, itchiness). Blind to the clinical results, 2 radiologists measured the scar thickness of the same sites with ultrasonography (5 to 10 MHz transducer, General Electric LOGIQ 500). The correlation between the clinical scores and ultrasound measurement of scar thickness were analysed using analysis of variance (ANOVA). Results: The median age of 58 children with scald injury (M:F = 36:22) was 2.8 years (0.5 to 15.8 years). The mean percentage of scald was 8.8% (24% had scald area >10%). In addition, there were 5 children with burn from naked flame and 9 children with keloid secondary to surgical incisions. With pressure garment therapy, the scar thickness reached a plateau 1½ years after the injury and began to decline gradually thereafter. The clinical estimation of scar thickness correlated well with the ultrasound measurement (ANOVA, P =.003, Adjusted R square = 0.99). The accuracy rate of clinical thickness estimation was 67%. Overestimation and underestimation accounted for 15% and 18%, respectively. There also was good correlation between total clinical score and the ultrasound measurement (ANOVA, P <.001). Conclusions: In children with scald injury, the pressure garment needs to be continued for a minimum of 1 year. Ultrasound measurement correlates well with overall score of the Vancouver General Hospital Burn Assessment Scale but not individual components of the scoring system except wound height. J Pediatr Surg 36:466-469. Copyright © 2001 by W.B. Saunders Company.

The Effects of Subconjunctival Verapamil on Filtering Blebs in Rabbits

Verapamil is a calcium antagonist that has been shown to modulate wound healing through multiple mechanisms. The wound modulating effects of verapamil were studied in a rabbit model of filtering surgery. Twenty New Zealand albino rabbits underwent a fistulizing procedure, with either verapamil or saline injected subconjunctivally daily for 6 days following surgery. The animals were sacrificed at 20 days after the fistulizing procedure. The effectiveness of verapamil in modulating wound healing was evaluated by bleb patency testing, histology, measurement of scar thickness, and counts of bromodeoxyuridine (BrdU)-labeled cells at the sclerostomy site. The group treated with verapamil had a 44 percent patency rate compared with 10 percent in the control group (P < .05), a mean scar thickness of 195.96 +/- 68 mu m compared with 313.55 +/- 110.4 mu m in the control group (P < .02), and a mean BrdU-labeled cell count of 15.5 +/- 14.7 compared with 26.3 +/- 17.0 in the control group (P < .002). Verapamil was effective in reducing scar formation at the sclerostomy site. At the doses administered, verapamil appeared to modulate wound healing in filtering blebs in the rabbit model. Further studies are needed to determine the dose-response and the efficacy of the drug in nonhuman primates.