Müller Bettina, Mazza Edoardo, Schiestl Clemens, Elrod Julia
Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland.
Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.
Burns Trauma. 2021 Sep 30;9:tkab028. doi: 10.1093/burnst/tkab028. eCollection 2021.
Hypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries. A better understanding of the characteristics of scar maturation and early prediction of the long-term outcome of scarring are prerequisites for improving targeted therapies and pivotal for patient counselling.
Repeated measurements of scar stiffness in 11 pediatric patients were performed over the course of 1 year using 2 suction devices, the Cutometer and the Nimble. In addition, the observer pliability score of the Patient and Observer Scar Assessment Scale was applied. This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time (using linear regression); the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict long-term scar maturation based on early scar assessment (using receiver operating characteristic).
All the tools used showed significant longitudinal decrease of scar stiffness from 3 months until 12 months after the injury. The Nimble (ICC = 0.99) and the Cutometer (ICC = 0.97) demonstrated an excellent ability to distinguish between individual patients. The Nimble seemed to be able to predict the 12-month pliability of scars based on early (3-month) measurements (area under the curve (AUC) = 0.67; AUC = 0.46; AUC = 0.79).
The results of this preliminary study suggest that all 3 tools provide suitable means to quantify alterations in scar stiffness over time. Initial evidence suggests the Nimble is most favorable for predicting changes in stiffness associated with long-term scar maturation. Further studies with a larger sample size are required to validate tissue suction as a clinical tool for analysis of changes of scar stiffness over time.
烧伤后肥厚性瘢痕是烧伤患者面临的最大未解决挑战之一。更好地了解瘢痕成熟的特征以及早期预测瘢痕形成的长期结果是改善靶向治疗的前提条件，也是患者咨询的关键。
使用两种吸力装置，即皮肤弹性仪（Cutometer）和Nimble，对11名儿科患者的瘢痕硬度进行了为期1年的重复测量。此外，还应用了患者和观察者瘢痕评估量表的观察者柔韧性评分。这项纵向研究能够量化每个测量参数反映瘢痕成熟的能力，瘢痕成熟表现为皮肤柔韧性/硬度随时间的变化（使用线性回归）；区分个体患者的能力（组内相关系数（ICC））；两种装置之间的相关性（斯皮尔曼相关系数）；以及基于早期瘢痕评估预测长期瘢痕成熟的能力（使用受试者工作特征曲线）。
所有使用的工具均显示，从受伤后3个月到12个月，瘢痕硬度显著纵向降低。Nimble（ICC = 0.99）和皮肤弹性仪（ICC = 0.97）在区分个体患者方面表现出卓越的能力。Nimble似乎能够根据早期（3个月）测量结果预测瘢痕在12个月时的柔韧性（曲线下面积（AUC）= 0.67；AUC = 0.46；AUC = 0.79）。
这项初步研究的结果表明，所有这三种工具都提供了合适的方法来量化瘢痕硬度随时间的变化。初步证据表明，Nimble最有利于预测与长期瘢痕成熟相关的硬度变化。需要进行更大样本量的进一步研究，以验证组织吸力作为分析瘢痕硬度随时间变化的临床工具的有效性。
