Patient Scar Assessment Scale Scores Research Articles

First results of laser treatment in our pediatric burn patients

Objectives: This study aimed to share the first results of the laser application we started using in our center to treat hypertrophic scars formed after burns. Patients and methods: The retrospective study was conducted with 10 pediatric patients (5 males, 5 females; median age: 3.5 years; range, 30 month to 10 years) treated for post-burn hypertrophic scars between January 2023 and July 2023. Burn patients to whom we applied Nd:YAG (neodymium:yttrium aluminum garnet) laser due to complaints such as contracture, hypertrophic scar, and itching were evaluated. Of all patients who underwent laser application, some received intralesional steroid application during the same session. The patient's age, sex, burn agent, burn percentage, scar areas, number of sessions, post-laser complaints, findings, the patient scar assessment scale (PSAS), and the observer scar assessment scale (OSAS) were evaluated. Results: The burn agent was two flame burns and eight scald burns. A graft was not applied in four patients, and a graft was used in six patients. The time between the burn dates and laser application ranged between seven months and eight years. One patient underwent four laser sessions, one patient had three laser sessions, and the other patients underwent one session. It was observed in the controls that after laser application, the itching decreased significantly, the hypertrophic scar softened, and its color faded. The PSAS and OSAS scores were found to be statistically significantly reduced (p< 0.01). Conclusion: In the treatment of post-burn hypertrophic scars with Nd:YAG laser treatment, the hypertrophic scar softens, its color fades, itching decreases significantly, and there is a decrease in contracture. Treatment satisfaction of patients and parents had a positive psychological impact on the family. Furthermore, laser therapy can reduce the cost of expensive post-burn care. The increasing use of laser applications also reveals the need for standardization.

Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy

Objectives: This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed. Results: The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively). Conclusion: Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision. Keywords: Laparoscopy; Trocar; Egypt.

The effect of incisional negative pressure wound therapy on the improvement of postoperative cosmetic suture wounds and scar hyperplasia.

This study aimed to explore the effects of early incisional negative pressure wound therapy (INPWT) on cosmetic suture wounds and postoperative scar hyperplasia. We retrospectively evaluated 120 patients who underwent abdominoperineal resection at the Changhai Hospital between February 2018 and October 2021 and divided them into two groups according to their treatment: the INPWT group (n = 60) and the control group (n = 60). The quality of post-surgical wound healing in the two groups was evaluated. The Patient Scar Assessment Scale (PSAS), the Vancouver Scar Scale (VSS), and the visual analogue scale (VAS) were used to evaluate the surgical incision scar at 1-year follow-up. At this follow-up visit, 115 patients underwent reexamination; five patients were lost to follow-up, including two patients in the INPWT group and three patients in the control group. The INPWT group showed better wound healing than the control group (P < .05). The proportion of patients who received INPWT was significantly higher in the non-surgical site infection (SSI) group than in the SSI group (P < .05). The PSAS, VSS and VAS scores were significantly improved in the INPWT group compared with those in the control group (P < .05). Our results show that INPWT improved the quality of cosmetic suture wounds and reduced the degree of postoperative scar hyperplasia.

Tunneled island pedicle flap reconstruction for upper lateral cutaneous lip defects

Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83±4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81±1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10±5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2±1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers.

Patients’ satisfaction with the effects of microporous tape on surgical scars: a randomized controlled study

Background Following surgery or other types of trauma, scar formation occurs with wound healing because of the replacement of normal skin with fibrous tissue. The conversion of a normal scar to an abnormal scar usually occurs 6 to 8 weeks after surgery. Abnormal scars can be a source of patient dissatisfaction, especially following cosmetic surgical procedures. Therefore, supporting scars with tape after surgery is critical for reducing scar tension. The aim of this study was to determine the extent of patients’ satisfaction with their scar outcomes following microporous taping and to identify the determinants of scar satisfaction.Methods A prospective randomized controlled study was conducted to compare the scar satisfaction of postsurgical patients who underwent scar taping with microporous tape to those who did not. The scars were assessed at 6 weeks, 3 months, and 6 months after surgery using the Patient Scar Assessment Scale (PSAS). The test group had microporous tape applied to their scars and the tape was worn 24 hours a day for a period of 6 months. The data were analyzed using SPSS version 22.0. Categorical variables and mean PSAS scores were compared using the chi-square test and repeated-measures analysis of variance, respectively.Results At 6 weeks, 3 months, and 6 months the taped group had significantly lower PSAS scores and higher satisfaction scores than the control group. Scar thickness and pruritus were statistically significant determinants of patient satisfaction.Conclusions Microporous tape is an effective modality for improving scar satisfaction in postsurgical patients.

Translation and psychometric validation of the Finnish version of the Patient Scar Assessment Scale for use in patients with burn scars

BackgroundThe aim of this study was to create a Finnish scar assessment scale by translating and evaluating the psychometric properties of the Patient Scar Assessment Scale (PSAS), a part of the Patient and Observer Scar Assessment Scale (POSAS), with burn patients to enable its use in burn care. MethodsThe translation process followed international guidelines with forward and backward translations and cognitive debriefing with patients. Psychometric validation was performed with adult patients with burns who had been treated at the Helsinki Burn Centre between 2006 and 2017 with skin grafting following the excision of deep second- or third-degree burns. To ensure reproducibility, the PSAS was sent to the study participants twice. The correlation between the PSAS and health-related quality of life (HRQL) was also tested. ResultsIn total, 192 patients, of whom 71 % were male, participated in this study. The mean (SD) age of the participants was 57 (17) years. The internal consistency of the PSAS was good, Cronbach's α 0.89 (95 % CI: 0.86–0.91). The reproducibility was also good concerning all items and the total score, ICC from 0.77 to 0.89. As expected, the total PSAS score correlated negatively with HRQL. ConclusionThe PSAS was successfully translated and culturally adapted into Finnish and the newly translated version has good validity and reproducibility for assessing mature burn scars.

The Efficacy and Safety of Botulinum Toxin Type A Injections in Improving Facial Scars: A Systematic Review and Meta-Analysis

Background: Botulinum toxin type A (BTA) has a wide range of clinical applications, and its use in improving aesthetics is one of them. The aim of this study was to better assess the efficacy and safety of BTA in patients with facial scars. Summary: We extracted the data of the visual analog scale (VAS) score, Vancouver scar scale (VSS) score, scar width, observer scar assessment scale (OSAS), patient scar assessment scale (PSAS), and/or drug-related adverse events. Five studies provided the data of VAS score, and the results showed that the VAS score in the BTA group was significantly higher than that in the control group. Three randomized controlled trials (RCTs) reported the VSS score. A statistically significant difference exists between the BTA group and the control group. Three RCTs reported the scar width after BTA treatment. A more favorable change was found in the BTA group with scar width even without statistical significance. Data about the OSAS and PSAS scores were available in two trials. There was no significant difference in OSAS and PSAS scores between the BTA group and the control group. Only three studies recorded three slight adverse events. There were no reports of severe complications. In conclusions, this study demonstrated that BTA has the potential to improve facial scars with an acceptable safety profile.

Factors Related to Patient Satisfaction Level of Thyroid Tumor on Post- Operative Thyroidectomy Scar Based on Patient Scar Assessment Scale (PSAS) in General Hospital Dr. M. Djamil Padang

A B S T R A C TIntroduction : Dr. M. Djamil Padang General Hospital (RSUP) still appliesconventional methods as thyroidectomy treatment. Satisfaction and comfort to thescar is one of the issues because conventional thyroidectomy surgery scars arelocated in the neck area that will affect the confidence of patients, especially women.Method: This research was a quantitative research using cross sectional studydesign. The research was conducted at The Oncology Surgery Polyclinic of RSUPDr.M. Djamil Padang with a sample of 50 respondents. Result: More than half ofthyroid tumor patients found were women (56%), most patients had totalthyroidectomy surgery (70%) with malignan tumor type (72%), and the most tumorsize in the T4 group (52%). The average age of patients during surgery was 54.26years. The average patient satisfaction score for post-thyroidectomy scars was 14.72with a total score of 16, the lowest score was 6 and the highest score was 22.Significant relationships were found in variable tumor size (p= 0.000), type of surgery(p= 0.005), tumor type (p=0.004) and gender (p = 0.028), while there was nostatistically significant relationship between age and patient satisfaction with post-thyroidectomy scars (p=0,176). Conclusion: There were significant relationshipsbetween gender, type of surgery, type of tumor, tumor size to patient satisfactionwith post-thyroidectomy scars, while age has no signifacnt relationship to patientsatisfaction with post-thyroidectomy scars. A small number of PSAS score showedthat the average patient was satisfied with post-thyroidectomy scar.

Appearance characteristics of incision, satisfaction with the aesthetic effect, and quality of life in of thyroid cancer patients after thyroidectomy.

This study aimed to assess the correlation between satisfaction with aesthetic effect (SAE) and quality of life (QoL) in thyroid cancer patients after thyroidectomy and identify the impact of appearance characteristics of scars on SAE. This prospective, single-centre, cross-sectional study from November 2018 to June 2019 enrolled 285 thyroid cancer patients three months after their thyroidectomy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 was used to assess QoL 3 months after thyroidectomy, while the Patient Scar Assessment Scale (PSAS) was used to assess the SAE of patients. The mean PSAS score was 35.00, and the mean QoL score was 69.96. Correlation analysis demonstrated that PSAS was negatively correlated with QoL score. Multivariate logistic regression analysis demonstrated that age, marital status, radiotherapy, surgery type, neurological deficits, and PSAS were independent risk factors with decreased QoL. Furthermore, correlation analysis showed that scar colour, stiffness, thickness, irregularity and length were positively correlated with poor PSAS. Scar irregularity and length were independent risk factors with poor PSAS. This study demonstrated that scar irregularity and length were independent risk factors with SAE, and poor SAE was correlated with decreased QoL in thyroid cancer patients after thyroidectomy.

Assessment of Functional Recovery and Subjective Donor-Site Morbidity Following Radial Forearm Flap Reconstruction in Small- to Moderate-Sized Palatal Defects.

Palatal defects are encountered following tumor extirpation, trauma, or congenitally. Among the known alternatives, radial artery free forearm flap (RAFF) is a versatile flap that confers good results in head and neck reconstruction, but donor-site morbidity has been an issue of discontent among the plastic surgeons. This limitation needs to be studied further and addressed considering the unmatched quality of this tissue. This study aims to weigh the impact of the functional edge of this flap against the unpopular donor-site morbidity on a group of patients. This is a retrospective analysis of recuperation of palatal function and patient concerns with the donor-site function and cosmesis on 7 consecutive patients with small-to-moderate palatal defects reconstructed with RAFF. Postoperative recovery of speech, palatal movement, and restoration of oromaxillary interface was assessed using objective tests, such as speech intelligibility testing and articulation studies. Simultaneously, subjective donor-site function and cosmesis were assessed using Patient Scar Assessment Scale (PSAS), Upper Extremity Functional Index (UEFI), and donor limb sensory testing. Mean PSAS score was 8.28/60, and UEFI score reported was 77/80, which reflect high patient satisfaction with the donor site. Nasoendoscopy shows remarkable restoration of palate anatomy. Intelligibility testing depicts near-normal speech understandability, whereas articulation studies revealed distortions post-palatal reconstruction with RAFF. Radial artery free forearm flap should be considered as the forerunner of reconstruction in palatal defects involving less than 50%.

Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure

Objective: To evaluate patient satisfaction and patient and physician assessment of scar appearance after cesarean skin closure with suture versus staples.Methods: Women undergoing cesarean delivery (CD) at ≥23 weeks’ gestation via low-transverse skin incisions at three hospitals in the CROSS Consortium were randomized to receive skin closure using subcuticular absorbable suture or nonabsorbable metal staples. The primary outcome of this substudy, patient satisfaction, was assessed by surveys at the postpartum visit using a 10-point Likert scale. Scar outcomes according to patients and trained observers were assessed at the primary research site using the Patient and Observer Scar Assessment Scale (POSAS). The POSAS is comprised of a patient-completed assessment including subjective data such as pain and itchiness, and an observer-completed assessment about cosmetic criteria.Results: Between June 2010 and August 2012, 746 women were randomized; 370 received suture and 376 received staples. Satisfaction data were available for 606 (81%). Complete patient scar assessment data were available for 577 (77%) and complete observer scar assessment data were available for 275 (57% of the 480 planned for evaluation at the primary research site). Demographic data for women in the two groups were similar. Satisfaction with the closure method was higher (superior) among women who received suture closure: median 10 (interquartile range 9, 10) versus 9 (interquartile ranges (IQR) 6, 10); p < .01. The suture group also had higher satisfaction with the scar’s appearance at the postpartum visit: median nine (IQR 7, 10) versus 8 (IQR 6, 10); p = .02. Receiving one’s preferred closure method was associated with higher patient satisfaction, and wound complications were associated with lower satisfaction. POSAS scores were superior (lower) in the suture group. Patient Scar Assessment Scale scores were median 15 (IQR 10, 25) for sutures versus 20 (IQR 11, 28) for staples; p < .01. Observer Scar Assessment Scale scores were median 12 (IQR 9, 15) for sutures versus 13 (IQR 9, 16) for staples; p = .01.Conclusions: Satisfaction with the closure method, satisfaction with the scar’s appearance, and patient and physician assessments of scar cosmesis were all superior in those closed with suture. These results further support the use of sutures for cesarean skin closure.Trial registration: ClinicalTrials.gov identifier: NCT01211600.

Observation on the clinical application effects of skin distractor on the treatment of scars

Objective: To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body. Methods: One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ(2) test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test. Results: (1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients' overall scores, and observers' overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P<0.05 or P<0.01]. Conclusions: Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

Use of 2-Octyl Cyanoacrylate Together with a Self-Adhering Mesh (Dermabond™ Prineo™) for Skin Closure Following Abdominoplasty: An Open, Prospective, Controlled, Randomized, Clinical Study

Abdominoplasty is one of the most commonly performed procedures in plastic surgery. The appearance of the scar is a major factor that contributes to the aesthetic outcome of the procedure and depends largely on the technique of wound closure. The new Prineo™ wound closure system was introduced to combine the effectiveness of 2-octyl cyanoacrylate (Dermabond™) together with a self-adhering mesh. Fifty-two women and eight men aged between 21 and 65 years who were scheduled for abdominoplasty were included in the study. The total operating times after abdominoplasty of the traditional wound closure technique and the Prineo™-type wound closure technique were compared. Furthermore, an analysis comparing the cost of the two methods was performed. Two weeks after surgery the wounds were examined and graded using the Hollander Cosmesis Scale. At the 6- and 12-month follow-ups, the aesthetic outcome of the abdominal scar was evaluated using the Vancouver Scar Scale. Twelve months after surgery, the patients were asked to answer their part of the Patient Scar Assessment Scale. The mean total operating time for the new skin closure system was statistically significantly shorter than that of intradermal sutures. The mean price difference per patient was 104.27<euro> (134.79$) in favor of Prineo™. The Hollander Cosmesis Scale indicated a significantly more favorable overall result with Prineo™ at 2 weeks after surgery. The Vancouver Scar Scale demonstrated a better cosmetic outcome in favor of Prineo™ 6 and 12 months after surgery. The Patient Scar Assessment Scale scores 12 months after surgery indicated that the patients noted significantly less pain, thickness, and irregularity with Prineo™. Based on our results, we conclude that Prineo™ is a safe and effective substitute for superficial skin closure, with good cosmetic results and no increase in wound complications. The use of Prineo™ decreases operative time and cost and enhances the patient's postoperative comfort. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Use of botulinum toxin type A to improve treatment of facial wounds: A prospective randomised study

The tension vectors acting on the wound edges are transmitted to immature collagen fibres synthesised during the normal healing phase. This accounts for scar widening as well as hypertrophic and hyperpigmented scars. The aim of our study was to evaluate whether early injections of botulinum toxin type A (BTA), which induces temporary muscular paralysis, decreases tension vectors on wound edges and enhances scarring of facial wounds. Thirty patients with facial wounds were enrolled in this study and randomised into two groups with or without injection of BTA within 72h postoperatively. BTA was injected into the facial muscles directly or indirectly involved in scar widening. Scars were assessed at a 1-year follow-up visit by patients using the Patient Scar Assessment Scale (PSAS) scale, by an independent evaluator using the Observer Scar Assessment Scale (OSAS) and the Vancouver Scar Scale (VSS), and by a board of six experienced medical specialists using the Visual Analogue Scale (VAS) with standardised photographs. At the 1-year visit, 24 patients were reviewed and six patients were lost to follow-up. No statistically significant differences were found between the two groups for the PSAS, OSAS and VSS scores. However, the median VAS rated by the six evaluators was 8.25 for the botulinum toxin-treated group compared with 6.35 for the control group. This result was statistically different, demonstrating improved scarring with BTA. Thanks to chemoimmobilisation, injections of BTA appear to improve cosmesis of facial wounds. Accordingly, they would be beneficial for use in young patients for wounds without tissue loss, lying perpendicular to the reduced tension lines of the skin of the face.

Long-term cosmetic results after minimally invasive video-assisted thyroidectomy

Minimally invasive video-assisted thyroidectomy (MIVAT) has been performed in the authors' department since 2004. Many authors have described some of its advantages over conventional surgery in terms of cosmetic results. The published literature on this topic variously describes the average central incision as 1 to 3 cm. The end point of the cosmetic results (e.g. the question of keloids) cannot be documented during the inpatient stay. This report describes the long-term cosmetic results for this method and analyzes the subjective and objective outcomes after MIVAT. From January 2004 until March 2010, 116 patients underwent MIVAT in the authors' department. The authors included 96 patients in their subsequent examination, with a follow-up period of 22.4 months (range, 1-64 months). The measurable cervical scar length was 1.9 cm (range, 1-3 cm). The measurable wideness of the cervical scar was 0.17 cm (range, 0.05-1.5 cm). Keloids in 10 female patients (10.4%) had diverse proliferation. Of the 116 patients, 93 (96.8%) were very satisfied or satisfied with the cosmetic result. The Patient Scar Assessment Scale score was 9.7, and of the Observer Scar Assessment Scale score was 8.1. In terms of long-term results, MIVAT appears to provide excellent cosmetic outcomes. The problem with the development of keloids in the region of the cervical incision, especially in female patients, remains unresolved. The satisfaction of patients with the long-term outcome of MIVAT is high.