Healing time and incidence of hypertrophic scarring in paediatric scalds

Scald burns, which heal in less than 14 days, are seen to be at low risk of hypertrophic scar (HTS) formation. Consequently surgery is usually reserved for scalds likely to take more than 14 days to heal. With the use of silver based dressings over the past few years, anecdotally, we have observed a tendency to improved healing of scalds with conservative management and reduced need for surgical intervention. We aimed to investigate the effect of overall healing time of paediatric scalds on HTS formation over a five-year period (2011-15).

We retrospectively identified all new patients attending the Royal Children's Hospital (RCH) burns clinic from 31st January 2011-31st July 2015. Medical histories were reviewed for burns caused by scalds. Scar quality was determined from written records or clinical photographs. Patients were compared in groups based on healing time of <10 days, 10-14 days, 15-21 days, 22-30 days or >30 days.

We studied 322 children, of which 52 (16.1%) developed HTS. There was a significantly higher incidence of HTS with increased time to healing (mean 34.5 days compared to 12.1 days, p<0.01). There were 25 patients that underwent surgical treatment with excision or debridement and split thickness skin graft of which 21 (84%) developed HTS. Grafting offered no benefit in HTS rate in the 22-30 days to heal group.

Our study confirms that there is a link between prolonged healing time of scald wounds and HTS. The danger of slow healing for scarring despite grafting, suggests this operation should be performed earlier than current practice to allow complete healing in less than 3 weeks.