Wamsley Christine E, Vingan Nicole, Barillas Jennifer, Culver Abby, Turer David M, Kenkel Jeffrey M
Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
Aesthet Surg J Open Forum. 2022 Feb 17;4:ojab059. doi: 10.1093/asjof/ojab059. eCollection 2022.
While validated scales must be created in order to systemically evaluate patients and quantify outcomes of aesthetic hand treatments, scales currently available are limited to the analysis of volume loss alone.
The purpose of this study was to develop 3 validated scales for the assessment of dorsal hand aging that also take into consideration wrinkling and pigmentation.
Fifty (50) healthy volunteers (40 females and 10 males) with Fitzpatrick skin types I-IV were recruited, and standard photographs of their left and right dorsal hands were taken with a Nikon D7100 (Nikon; Minato, Tokyo, Japan) camera. Using 25 randomized photographs, 11 plastic surgery physicians (3 chief residents, 6 senior residents, and 2 aesthetic surgery fellows) were trained on the 3 scales under investigation as well as the already-validated Merz Hand Grading Scale (MHGS). The evaluators then viewed the remaining 75 photographs independently and assigned a grade for each of the 4 scales to each photograph. Inter-rater variability was calculated for each scale.
The Kappa score for the MHGS was 0.25, indicating fair agreement; 0.40 for wrinkle scale, indicating fair agreement; and 0.48 and 0.46 for the pigmentation density and intensity scales, respectively, indicating moderate agreement ( < 0.001).
The results show that after receiving training, the inter-rater agreement for the 3 scales under investigation was similar or slightly higher than that for the MHGS. These 3 photographic classification systems can be used consistently and reliably to characterize multiple signs of dorsal hand aging.
为了系统地评估患者并量化手部美容治疗的效果，必须创建经过验证的量表，但目前可用的量表仅限于单独分析体积损失。
本研究的目的是开发3种经过验证的量表，用于评估手背老化情况，同时也考虑皱纹和色素沉着。
招募了50名（40名女性和10名男性）皮肤菲茨帕特里克分型为I-IV型的健康志愿者，用尼康D7100（尼康；日本东京港区）相机拍摄他们左右手背的标准照片。使用25张随机照片，对11名整形外科医生（3名住院总医师、6名高级住院医师和2名美容外科进修医生）进行了关于3种研究中的量表以及已验证的默茨手部分级量表（MHGS）的培训。然后，评估人员独立查看其余75张照片，并为每张照片的4种量表分别打分。计算每种量表的评分者间变异性。
MHGS的kappa值为0.25，表明一致性一般；皱纹量表的kappa值为0.40，表明一致性一般；色素沉着密度和强度量表的kappa值分别为0.48和0.46，表明一致性中等（P < 0.001）。
结果表明，经过培训后，3种研究中的量表的评分者间一致性与MHGS相似或略高。这3种摄影分类系统可用于一致且可靠地表征手背老化的多种迹象。
