Assessing Scar Outcomes Using Objective Scar Measurement Tools: An Adjunct to Validated Scar Evaluation Scales.

INTRO: The assessment of scar outcomes is important to both patient care and research focused on understanding the results of medical and surgical interventions. The Vancouver Scar Scale and Patient and Observer Scar Assessment Scale are validated and simple instruments to assess scars. However, these subjective scales have shortcomings. The VSS fails to capture patient perception and has indeterminate validity and reliability. The POSAS captures patient perception, but the observer scale has been shown to have moderate amounts of inter-rater variability. Studies highlighting the ability of objective scar assessment tools to produce reliable and reproducible results are needed. In this study, we aimed to validate the use of the Fibrometer ®, Elastimeter ®, and SkinColorCatch ® as an objective adjunct in the assessment of hypertrophic scar and keloid outcomes. METHODS: This was a prospective single-center study which assessed patient scars using the Vancouver Scar Scale, the Patient and Observer Scar Assessment scale, and the aforementioned objective study tools. Correlations between the different methods of scar assessment were measured. RESULTS: The Fibrometer ® and SkinColorCatch ® showed significant correlations with the VSS total and the Observer POSAS total. The Elastimeter ® showed significant correlations with both the Patient and Observer POSAS totals. Unexpected correlations between Elastimeter ® measurements and the vascularity/pigmentation of scars indicate that scoring of these categories may be influenced by how severe the scar looks to the observer subjectively, further necessitating the need for reliable objective scar assessment tools. CONCLUSION: These results highlight the ability of these devices to assess scars and demonstrate their potential in serving as an important adjunct to previously validated scar assessment scales.

Laser-Assisted Drug Delivery in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review.

Hypertrophic scars and keloids are the results of an exaggerated healing process and are often associated with significant patient morbidity. Fractional ablative lasers create microchannels in the skin and penetrate into the substance of the scar, inducing a normal healing response in zones of created damage. Focal delivery of scar-modulating agents into the scar through these microchannels-a process termed laser-assisted drug delivery (LADD)-is a promising and developing treatment modality. In this systematic review, we aim to critically examine the evidence of LADD in the treatment of hypertrophic scars and keloids. The evidence suggests that LADD improves outcomes in hypertrophic scars and keloids. LADD is a more effective treatment modality than the topical application of agents in hypertrophic scars and equally effective as the intralesional injection of agents in keloids. There were few reports of adverse events. Evidence supports the use of LADD as an adjunct to non-surgical measures or a treatment modality to be used before more invasive measures such as surgical excision. However, the quality of evidence supporting this conclusion is inconsistent and lacks power. Additional studies are required to optimize dosages, laser settings, and agent choices for the treatment of these lesions.

Combining scar-modulating agents for the treatment of hypertrophic scars and keloids: A systematic review.

Injury to the skin can cause abnormal wound healing and continuous inflammation that leads to the formation of hypertrophic scars and keloids. These lesions often cause significant negative impact on a patient's life due to aesthetic, physical, social, and psychological consequences. Numerous treatment modalities exist for these hypertrophic scars and keloids, which include silicone sheeting, pressure garments, intralesional injection/topical application of scar-modulating agents, laser therapy, and surgical excision. Due to increased efficacy, an evolving treatment paradigm encourages the use of multiple treatment modalities instead of one treatment modality. However, no gold standard treatment exists for these lesions, leaving many people with unsatisfactory results. Adding scar-modulating agents such as 5-Fluorouracil, bleomycin, or Botulinum Toxin A to triamcinolone monotherapy has emerged as a potential drug combination for treating hypertrophic scars and keloids. We sought to critically analyze the evidence that exists for the use of more than one scar-modulating agent. This was done by conducting a systematic review to determine the efficacy of these combined drug regimens. We found that many of these combinations show evidence of increased efficacy and fewer/similar adverse events to triamcinolone monotherapy. Triamcinolone and 5-Fluorouracil showed the strongest and most consistent evidence out of all combinations. With this review, we intend to encourage more research into unique drug combinations that may improve outcomes for patients with symptomatic hypertrophic scars or keloids.

A comparison of negative pressure wound therapy modalities, VAC versus non-commercial NPWT alternatives: A systematic review of RCTs/CCTs.

BACKGROUND: Negative pressure wound therapy (NPWT) has been described as an effective treatment for wounds of various etiologies, however it is expensive. Various authors have investigated low-cost alternatives to commercial NPWT devices. A systematic review summarizing their findings is needed for clinicians operating in resource-limited locations and for those interested in potential cost savings. METHODS: A systematic review was performed evaluating articles from Cochrane, PubMed and EMBASE. The studies included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared commercially available Vacuum-Assisted Closure (VAC) devices with non-commercial NPWT modalities in human subjects. RESULTS: Seven hundred and ninety-six articles were retrieved, of which six met inclusion criteria. All six studies were RCTs and had in total 409 participants with wounds of various etiologies, including acute, chronic, and traumatic wounds. All studies compared VAC to a non-commercial NPWT device. Five studies were found to have low risk of bias, and one study had high risk of bias. There were three types of non-commercial NPWT devices used: wall suction applied to a sealed gauze dressing (GSUC), AquaVac, and Redon drains. The following outcomes were assessed: granulation tissue formation, effect on wound size area, skin graft take, pain/time associated with dressing changes and cost. In trials that compared GSUC vs VAC, there was no significant difference between the two groups for the following outcomes: granulation tissue formation, effect on wound size and skin graft take. GSUC dressings were significantly less painful and less time-consuming than VAC dressings. In the trial that compared AquaVac vs VAC, there was no significant difference between the two groups for the following outcomes: granulation tissue formation, effect on wound size, and the time or pain associated with dressing changes. In the trial that compared Redon drains vs VAC, there was significantly more granulation tissue formed in the VAC group. All non-commercial NPWT devices were found to be less costly than VAC. CONCLUSION: The data from the trials evaluated in this review indicate that GSUC and AquaVac are two non-commercial NPWT devices that are non-inferior to VAC for various outcomes while also being less costly. GSUC was less painful and less time-consuming than VAC. Of the non-commercial NPWT devices evaluated in this review, GSUC had the most evidence to support its future use. Prospective, multi-institutional RCTs with a large sample size are needed to confirm the findings presented here.