Goverman Jeremy, He Waverley, Martello Geoffrey, Whalen Ann, Bittner Edward, Schulz John, Gibran Nicole, Herndon David, Suman Oscar, Kowalske Karen, Meyer Walter J, Ryan Colleen, Schneider Jeffrey
Harvard Medical School.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Ann Plast Surg. 2019 Mar;82(3 Suppl 2):S162-S168. doi: 10.1097/SAP.0000000000001826.
Postburn scarring is common, but the risk factors, natural history, and consequences of such scars are still poorly understood. This study aims to describe the frequency of scar-related morbidity for up to 2 years after injury and to analyze the impact of burn scars on long-term functional, psychosocial, and reintegration outcomes.
Analysis was conducted on data collected between January 2006 and May 2014 from 960 patients (2440 anatomic burn sites) using the Burn Model System (BMS) database. Study population demographics were analyzed and odds ratios for the development of raised or thick scarring were determined. Regression analyses were used to evaluate the impact of hypertrophic scarring (HTS) on psychosocial outcomes, including the Community Integration Questionnaire, Satisfaction with Life Scale, Distress, and the Short Form 12. Symptoms associated with scarring were analyzed at discharge and 6, 12, and 24 months after burn using a set of questions on scarring developed by the BMS. Mixed-effect modeling was used to determine linear change over time and the significance of symptoms.
The study population was primarily white (65.0%) and male (71.8%), with a mean (SD) age of 44.0 (15.2) years and mean total body surface area burned of 19.6% (17.9%). The incidence of raised or thick scars increased from 65% to 80% (P < 0.0001) for the 2-year follow-up period. The presence of scarring was not associated with Community Integration Questionnaire, Satisfaction with Life Scale, or Short Form 12 scores. Most patients reported symptoms associated with scarring at 2 years after burn, including dry or fragile skin, scars that restrict range of motion at a joint, issues with hand function, and scar pain and itch.
In this large, longitudinal, multicenter cohort of burn survivors, nearly all patients noted the presence of scarring, and a majority noted additional symptoms and morbidity related to their scars even at 2 years after injury. This study demonstrates a need for the continued support of burn survivors to address scar-related morbidity. Furthermore, future studies examining the impact of novel treatments for scarring should use similar scar problem questionnaires and distress scores.
烧伤后瘢痕形成很常见，但此类瘢痕的危险因素、自然病程及后果仍未得到充分了解。本研究旨在描述受伤后长达2年的瘢痕相关发病率，并分析烧伤瘢痕对长期功能、心理社会及重新融入社会结果的影响。
使用烧伤模型系统（BMS）数据库，对2006年1月至2014年5月期间收集的960例患者（2440个解剖学烧伤部位）的数据进行分析。分析研究人群的人口统计学特征，并确定出现隆起或增厚瘢痕的比值比。采用回归分析评估增生性瘢痕（HTS）对心理社会结果的影响，包括社区融入问卷、生活满意度量表、痛苦程度及简短健康调查问卷12项。在出院时以及烧伤后6个月、12个月和24个月，使用BMS制定的一组关于瘢痕形成的问题，分析与瘢痕形成相关的症状。采用混合效应模型确定随时间的线性变化及症状的显著性。
研究人群主要为白人（65.0%）和男性（71.8%），平均（标准差）年龄为44.0（15.2）岁，平均烧伤总面积为19.6%（17.9%）。在2年随访期内，隆起或增厚瘢痕的发生率从65%增至80%（P<0.0001）。瘢痕形成与社区融入问卷、生活满意度量表或简短健康调查问卷12项评分无关。大多数患者在烧伤后2年报告了与瘢痕形成相关的症状，包括皮肤干燥或脆弱、限制关节活动范围的瘢痕、手部功能问题以及瘢痕疼痛和瘙痒。
在这个大型、纵向、多中心的烧伤幸存者队列中，几乎所有患者都注意到有瘢痕形成情况，而且即使在受伤2年后，大多数患者仍注意到与瘢痕相关的其他症状和发病率。本研究表明需要持续支持烧伤幸存者以解决与瘢痕相关的发病率问题。此外，未来研究新型瘢痕治疗方法的影响时，应使用类似的瘢痕问题问卷和痛苦程度评分。
