Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation:a qualitative study

Background:Scar assessment plays a key role during burns aftercare,to monitor scar remodelling and patients’psychosocial well-being.To aid assessment,subjective scar assessment scales are available that use health-care professionals’and patients’opinions to score scar characteristics.The subjective scales are more widely used in clinical practice over objective scar measures.To date,there is no research that considers patients’views on scar assessment and the role of subjective and objective assessment tools.Therefore,the aim of this qualitative study was to explore patients’perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation.Methods:Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring.Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital,Birmingham,UK.Topics covered during interview included patient experience of scar assessment,the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars.A thematic analysis using the Framework Method was conducted.Results:Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment.These are:patient-led care;continuity in care;learning how to self-manage scarring;and psychological assessment.Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies,indicating their potential patient-centred contributions.The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools.Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial function-ing.However,minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose.Patients perceived objective tools to be of primary use for health-care professionals,though the measures may aid patients’understanding of scar properties.Conclusions:Scar assessment tools should be used to support,rather than replace,health-care professionals’subjective judgements of scarring.Adapting the way in which clinicians introduce and use scar assessment tools,according to patient needs,can support a patient-centred approach to scar assessment.

Effect of Dermabrasion and ReCell on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes

Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.