Challenging the dogma: relationship between time to healing and formation of hypertrophic scars after burn injuries

Hypertrophic scarring (HTS) is defined as a scar, which is raised above the skin level and remains within the confines of the original lesion. The authors hypothesize that small surface area burns can be left to heal beyond 21 days without an increase in the incidence of HTS formation, within the confines of a carefully selected patient population. The authors have documented the number of days to healing in all patients conservatively managed in their outpatient burns clinic. All patients who took longer than 21 days to heal receive a follow-up telephone call. A multivariate regression analysis is used to confirm significant factors that impede healing time. This study included 181 conservatively managed burns with a male:female ratio of 1.63:1 and average age of 24.7 ± 21.69 years (range, 1 month to 85 years). In total, 32 patients (18%) took more than 21 days to heal (range, 22-88 days), of which five patients presented with HTS (days to healing range, 23-47; one mixed depth and four deep dermal). One patient did not attend for follow-up, two patients settled with silicone gel alone whereas one settled with pressure garments. One patient is still being seen. The only significant factor in predicting time to healing in the ANOVA model in this study was depth of burn (P = .01; confidence interval, 1.18-6.07). Advances in wound care and better understanding of the physiological processes involved in healing may now enable the management of smaller burns with dressings, delaying the need for early surgical debridement and skin grafting in certain individuals.