Sex, age, burn site, number of surgical procedures and the type of skin graft are associated with abnormal scarring following burns, according to a report in the March/April 2008 issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
The survival rate of patients with burns has dramatically increased over the past few decades, but healing burns almost always form scars, according to background information in the article. “Burn scars have a dramatic influence on a patient’s quality of life,” the authors write. “They have been associated with anxiety, social avoidance, depression, a disruption in activities of daily living, the onset of sleep disturbances and all of the consequent difficulties in returning to normal life after physical rehabilitation.”
Normal scars are characterized by minor alterations in skin properties, whereas disturbances in the wound healing process produce abnormal or pathologic scars. Ezio Nicola Gangemi, M.D., and colleagues at the University of Turin, Italy, analyzed the records of 703 patients treated at an outpatient burn clinic between 1994 and 2006. In addition to the sex, age, total burn surface, cause of the burn and wound healing time, they noted the prevalence and evolution of several types of pathologic scars: hypertrophic (enlarged) scars; contracted scars, which shorten the length of the tissue; and scars with both characteristics.
Of the 703 patients, 540 (77 percent) had pathologic scars, including 310 (44 percent) with hypertrophic scars, 34 (5 percent) with contractures and 196 (28 percent) with hypertrophic-contracted scars. Patients who were female, young, burned on the neck or arms, had multiple surgical procedures or received meshed skin grafts (sections of skin that have been mechanically cut and expanded, as opposed to sheet or solid grafts) all had a higher risk of pathologic scarring.
Questions remain regarding the clinical course of post-burn scarring, the authors note. “Our data seem to support the role of the immune system for a number of reasons,” they write. Females have a higher risk for both pathologic burn scarring and most immune-related diseases, including rheumatoid arthritis and lupus. In addition, younger patients with more active immune systems are also more likely to develop abnormal scars.
The results could improve physicians’ approach to post-burn scarring, the authors note. “Risk information may be easily integrated into routine clinical practice for early risk stratification, thus facilitating optimal medical prevention and helping physicians adopt follow-up timing and more aggressive or experimental therapies for subjects likely to be at high risk,” they write.
Arch Facial Plast Surg. 2008; 10:93-102.