Weitemeyer Marie B, Bramsen Pernille, Klausen Tobias W, Hölmich Lisbet R, Gjorup Caroline A
a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark.
b Department of Haematology , Herlev and Gentofte Hospital, University of Copenhagen , Denmark.
J Plast Surg Hand Surg. 2018 Dec;52(6):319-324. doi: 10.1080/2000656X.2018.1493388. Epub 2018 Oct 31.
Wide local excision of the primary tumour is the mainstay of treatment for melanoma patients. The aims of this study were to assess the patient- and observer-reported long-term scar quality after surgery using the patient and observer scar assessment scale (POSAS) in melanoma patients, to assess the reliability and validity of POSAS, and to identify factors influencing the scar assessment. This cross-sectional clinical study included 320 melanoma patients with primary tumours on the trunk and limbs. Data regarding patients, treatment, scar characteristics and functional outcomes was analysed. Internal consistency, inter-rater reliability, and convergent validity were examined. Factors influencing the patient- and observer-reported scar quality were tested using regression analyses. Results of the POSAS showed an overall good scar quality. The internal consistency of POSAS was good, and the convergent validity was strong. The inter-rater reliability was only moderate. The patients were influenced by the POSAS sub-items: colour, irregularity, thickness and pain. The observer was influenced by the POSAS sub-items: vascularity, surface area, thickness, relief and pliability. Both patient- and observer-reported scar qualities were influenced by age, location, type of superficial suture, keloids and widened scars. Moreover, the patients were influenced by the scar tightness while the observer was influenced by postoperative complications, hypertrophic scars, suture marks and dog ears. In conclusion POSAS is a reliable and valid scar assessment tool. The factors influencing patient- and observer-reported scar quality differed, and better understanding of this may improve treatment and hence patient-reported scar quality.
原发性肿瘤的广泛局部切除是黑色素瘤患者治疗的主要方法。本研究的目的是使用患者和观察者瘢痕评估量表（POSAS）评估黑色素瘤患者术后患者和观察者报告的长期瘢痕质量，评估POSAS的可靠性和有效性，并确定影响瘢痕评估的因素。这项横断面临床研究纳入了320例躯干和四肢患有原发性肿瘤的黑色素瘤患者。分析了有关患者、治疗、瘢痕特征和功能结果的数据。检查了内部一致性、评分者间信度和收敛效度。使用回归分析测试影响患者和观察者报告的瘢痕质量的因素。POSAS的结果显示瘢痕质量总体良好。POSAS的内部一致性良好，收敛效度较强。评分者间信度仅为中等。患者受POSAS子项目的影响：颜色、不规则性、厚度和疼痛。观察者受POSAS子项目的影响：血管分布、表面积、厚度、起伏和柔韧性。患者和观察者报告的瘢痕质量均受年龄、部位、浅表缝合类型、瘢痕疙瘩和瘢痕增宽的影响。此外，患者受瘢痕紧绷度的影响，而观察者受术后并发症、增生性瘢痕、缝线痕迹和皮赘的影响。总之，POSAS是一种可靠且有效的瘢痕评估工具。影响患者和观察者报告的瘢痕质量的因素不同，更好地理解这一点可能会改善治疗，从而提高患者报告的瘢痕质量。
