Analysis of the predictors of hypertrophic scarring pain and neuropathic pain after burn.

INTRODUCTION: Burn hypertrophic scarring pain is a common and perennial complaint which not only affects patients' quality of life, but also their recovery and reintegration. Physical therapy and medicine regimens are all available for the treatment of hypertrophic scarring pain. Unfortunately, the efficacy of clinical practice is not very satisfactory and the management of hypertrophic scarring pain remains challenging. Therefore, it is of utmost importance to explore the risk factors for hypertrophic scarring pain and further identify whether it is neuropathic pain, aiming to guide the clinical therapy and help patients live a pain-free life. METHODS: This retrospective study enrolled patients with postburn hypertrophic scarring pain between 2017 and 2020 in a burn center in Shanghai. Research objects were included strictly according to the inclusion criteria and every enrolled patient was included in the study only once. Demographic information, burn and scar characteristics, and pain scores were collected through the Changhai Hospital Medical Information System, patient questionnaire and physician assessment. Using SPSS 26.0 software, the data were first processed by descriptive statistics, and linear and logistic regression analyses were further employed to explore the significant factors. RESULTS: The sample involving 123 patients was consisted of 56.9% males, 79.7% caused by fire with a median age 40.5 years, total body surface burn-area (TBSA) 44.4%, wound healing time of target scar 57.9 days, hyperplasia time 9.3 months and the scar location mainly in the limbs (55.3%). Of all the included objects, the modified Vancouver Scar Scale (mVSS) total, visual analogue scale (VAS) score, brief pain inventory (BPI) total and the percentage of neuropathic pain were 9.6, 3.3, 36.0 and 74.8%, respectively. Integrating covariates with a P value of <0.10 through preliminary univariate analysis, multivariable linear regression showed sex (P = 0.049), age (P = 0.020), target scar location (P = 0.017, P = 0.254), and pliability (P = 0.016) were linked with severe VAS score; and burn depth of target scar (P = 0.023), hyperplasia time (P = 0.027, P = 0.001), vascularity (P = 0.028), and pliability (P = 0.001) were associated with higher BPI score. Adjusting for potential confounders, hyperplasia time (P = 0.005, P = 0.039) was found to be the only independent risk factor for hypertrophic scarring neuropathic pain in the multivariate logistic regression analysis, with mVSS total of P = 0.062. CONCLUSIONS: The model in our study has clarified that sex, age, target scar location, burn depth of target scar, hyperplasia time, and vascularity, especially pliability, may provide excellent prediction of hypertrophic scarring pain outcome; for neuropathic pain, only hyperplasia time has further prospects, with mVSS total as a potential forecast. In an era increasingly aware of life quality, this work may contribute to the elaboration of strategies to hypertrophic scarring pain management, provide an individualized therapy, and help patients live a pain-free life.

Modified Vancouver Scar Scale score is linked with quality of life after burn.

INTRODUCTION: This study aimed to determine if a scar quality is associated with quality of life (QoL) at six months post-burn and beyond. METHODS: Quantile regression models adjusted for covariates were used to demonstrate the relationship of modified Vancouver Scar Scale (mVSS) total (with and without pigmentation) and the mVSS components, to the Burn Specific Health Scale-Brief (BSHS-B) scores (full scale, Affect and Relations domain, Skin Sensitivity domain). RESULTS: The sample (n=341) comprised 67% males, 83% with skin grafts with a median age 38 years, total body surface area (TBSA) 4%, length of stay seven days, mVSS total score of five and BSHS-B total score of 153. Between six and 12 months of injury, mVSS total, TBSA and female gender were significantly associated with the BSHS-B, a situation that was not affected by the presence or absence of pigmentation scores. The mVSS components did not individually influence QoL. DISCUSSION: mVSS total score, gender and burn size data may be a useful adjunct to experienced clinical judgment for identifying at risk patients and directing appropriate, timely resource allocation.

Assessment of Postoperative Scar Using Modified Vancouver Scar Scale of 283 Patients Who Underwent Open Thyroidectomy in a Single Institution / 대한내분비외과학회지

PURPOSE: The postoperative scar of open thyroidectomy is one of the clinical issues in patients diagnosed with thyroid disease. The aim of this study was to analyze postoperative scars in patients who underwent thyroidectomy based on the Modified Vancouver Scar Scale and to find factors for use in predicting formation of hypertrophied scars and keloids. METHODS: Clinical data from 283 patients who underwent thyroidectomy were collected randomly and analyzed retrospectively. All postoperative scars were classified according to five categories; excellent, good, moderate, hypertrophied, and keloid, using the Modified Vancouver Scar Scale according to the assessment of pliability, height of the scar, vascularity, and pigmentation. For analysis, hypertrophied and keloid were classified as bad status and others were classified as good status. RESULTS: According to our results, 84.8% of scars were classified as good status and 15.2% of scars were classified as bad status. Forty percent of patients who were in their twenties, 17.8% of patients who were in their thirties, and 22.1% of patients who were in their forties showed bad status; 92.9% of patients who were in their fifties and 89.2% of patients who were in their sixties showed good status (P=0.003). The only statistically significant factor influencing the scar status was the weight of the thyroid (P=0.022). CONCLUSION: Postoperative scars from thyroid surgery were evaluated using the Modified Vancouver Scar Scale. Age was the most important factor in formation of hypertrophied and keloid scar and the weight of the excised thyroid also influenced the scar status. Preoperative prediction of the status of the scar might be possible considering the age and size of the thyroid gland.