Subjective Tools for Burn Scar Assessment: An Integrative Review.

OBJECTIVE: To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES: The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION: After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION: Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS: Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS: The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.

[Observational study of the second-line nursing consultation in wounds and scarring: A didactic situation under construction]. / Étude descriptive de la consultation infirmière de deuxième ligne en plaies et cicatrisation : une situation didactique en construction.

Introduction and objective : In the activity of wound and scar nurses (Infirmières spécialisées en plaies et cicatrisation ; ISPC), the "second-line" nursing consultation is also an opportunity to offer applicants the opportunity for training. This study is part of an exploratory perspective, with the objective of questioning the didactic dimension of this type of consultation. To address the issue, attention is focused on the analysis of the ISPC's activity.Material and method : Two simple self-confrontation interviews of an ISPC are analyzed on the basis of video consultations.Results and discussion : Although the results identified remain incomplete since the interviews were based on a single individual, this article shows how the ISPC, after the interviews, is able to formulate future adjustments to their practice. The first avenue is to highlight a necessary transformation of the discourse of the ISPC during consultations. The second is to question the modality of the post-consultation follow-up.

Scars: impact and management, with a focus on topical silicone-based treatments.

Many people are living with scars caused by surgery or traumatic injury. Scar prevention in the early stages of wound healing is an essential aspect of care. Ongoing scar management is generally by self-care, using non-invasive methods such as silicone sheeting and/or massage. Silicone is considered to be the first-line non-invasive, prophylactic and therapeutic measure for scar management. Nurses have a role in supporting patients with self-care of their scars as well as providing psychological support, as the impact of a scar and effect of quality of life can be significant.

Diagnosis, treatment and management of epidermolysis bullosa.

Epidermis bullosa is a genetically inherited disease in which painful blistering of the skin or mucous membranes occurs after minor trauma. It is a lifelong problem. The diagnosis should be confirmed by a specialist, preferably at a specialist unit where a treatment plan and follow-up arrangements for professionals and families can be put in place. Nurses will be involved in frequent dressings of wounds, after extra analgesia, and may need to be alert to any need for further specialist referral, especially in the case of complications such as infection, deformities, gastrointestinal strictures and possible skin cancers. Genetic counselling should also be offered to families, especially when considering the possible risks to future pregnancies.

[Nursing care in situations of facial image alteration]. / O cuidado de enfermagem em situações de alteração da imagem facial.

This research studies how patients, nursing undergraduate students, and professors perceive the care of patients with facial image alterations, and the implications of this care to the education process. It followed an exploratory qualitative approach, and it was carried out in an university hospital in Santa Maria, Rio Grande do Sul, Brazil, between July 2008 and April 2009. Six patients with facial image alteration, seven nursing undergraduate students and five professors participated. Semistructured interviews and a focal group were used. The data were organized and submitted to the content analysis technique. Two categories were found: meaning of the altered facial image, and nursing education and care. The care to these patients is perceived as a complex, hard and striking experience, that constitutes a unique opportunity for the development of skills necessary to the nurse's education. It was observed the need to insert themes during education that address issues relevant to the needs of undergraduates, and enable them to reflect on their training experiences.

A review of current objective and subjective scar assessment tools.

An ideal scar assessment tool should include both objective and subjective methods aspects of a scar. This review examines the evidence on existing tools, and emphasises the importance of taking the patient's perspective into account.

[Psychological repercussion of the scars in the burned patient]. / Repercusión psicológica de las cicatrices en el paciente quemado.

The scars produced by burns have serious consequences for the patient. The repercussions go further than the discomfort, pain and physical restrictions, going as far as causing significant psychological consequences which can restrict the personal and social relationships of those affected. From the accounts told by two burn victims, and the technical analysis carried out by psychologists and psychiatrists specialised in this field, we gain a better understanding of the situation of these patients, on the basis of which we propose a series of nursing interventions designed to improve the care given in the area of wound healing.

Benefits of surgical reconstruction in pressure ulcers with a non-advancing edge and scar formation.

OBJECTIVE: To highlight the difficulty in treating pressure ulcers associated with scar formation and the benefits of surgical treatment in these cases by presenting a series of clinical cases. METHOD: Nine sacral ulcers surrounded by significant scar formation and 14 sacral ulcers without significant scars were treated using the same conservative management protocol. Healing status was quantitatively estimated using an assessment tool called DESIGN, which classifies pressure ulcer severity and allows healing to be monitored; a decreasing score indicates progressive improvement. RESULTS: Ulcers with scar formation showed little response to the treatment, while those without remarkable scars exhibited a significant decrease of the DESIGN scores. Surgical reconstruction was conducted in five ulcers surrounded by scar formation, and all showed complete healing within extremely short periods. CONCLUSION: Conservative treatment of pressure ulcers with a non-advancing edge surrounded by scar formation presents considerable difficulties. Surgical reconstruction offers many benefits for non-healing ulcers.

Wound care for patients with darkly pigmented skin.

This article examines the main skin or wound assessment parameters used for patients with darkly pigmented skin. Differences in skin pigmentation are discussed along with the challenges health professionals encounter in clinical practice and why linking theory to practice is vital.

Frequency of peristomal complications.

Practicing wound ostomy continence (WOC) nurses see peristomal complications in their ostomy patient population. The exact frequency and cause of these complications are unknown. Research into problems arising from prolonged use of ostomy appliances is lacking. To ascertain the frequency of peristomal complications, two WOC nurses at a major medical center prospectively assessed the peristomal skin of all new ostomy patients returning for their 2-month postoperative check-up using a peristomal complications tool. The study was conducted from August 1999 to August 2000. Descriptive statistics were used to summarize the data. In the course of the study, 161 new ostomy patients were seen, 10 with peristomal complications, for a frequency of 6%. The frequency of peristomal complications was the highest in people with ileal conduits (five of 34, 15%) and ileostomies (four of 46, 9%). Only one of the 81 people with a colostomy developed peristomal complications. All 10 patients had a retracted stoma. Eight had chemical damage (six with irritant dermatitis, two with pseudoverrucous lesions) and two had Candida infections. Although the study sample size is small, the results suggest that patients with ileal conduits and patients with retracted stomas may require more frequent follow-up visits to monitor skin conditions and pouching modifications.

Micropigmentation: a burn survivor's case study. Part 3.

A clinical methodology involving consultation, assessment, plan, implementation, and evaluation is important in meeting patients' skin care and cosmetic needs. Part III of this three-part series examines how this systematic and practical approach was used in camouflaging a burn survivor's appearance permanently.

Complications of cutaneous laser resurfacing: a nursing guide.

Laser use for various cutaneous conditions has advanced rapidly in the past several years. Initial background and physical history is important when determining if a patient is a candidate for laser resurfacing. Nurses must be able not only to identify appropriate candidates preoperatively, but to discuss the risks associated with the procedure. Because proper postoperative management is critical to the healing process, nurses must identify complications early in their course to provide appropriate intervention and, thus, reduce long-term side effects.

Surgical corrections of acne scars.

Acne, a disease of the pilosebaceous gland, may be mild or severe. Scarring, which occurs in both mild and severe disease, produces a variety of skin defects. Careful assessment of the types of scars along with knowledge about the multiple techniques available results in development of the most optimal plan for reconstruction.

A new treatment option for acne scars: allograft dermis.

Unsightly facial scars resulting from acne can be the source of painful emotional trauma. A new option for treating acne scars is described. It is pre-packaged dermal graft material that is easy to use, safe, and effective. A review of current treatment options and the steps for using this material are presented.

Cica-Care: adhesive gel sheet.

Keloid and hypertrophic scars can be a complication of burns, surgery and other traumas. Cica-Care (Smith & Nephew) has been developed for the prevention and treatment of such scars. This product focus presents the clinical features of both types of scars, highlighting the difference between them, and outlines the treatment options which include surgery, pressure treatment and pharmacological treatments. The mechanism of action of Cica-Care is still uncertain, but it appears to soften, flatten and blanch scars. The specific care of the gel sheet, including skin acclimatization, is also described.