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Published on: November 6, 2018
Scar outcomes for conservatively managed children post burn injury: A retrospective study
Stephanie Ball1, Stephanie Wicks2, Rhianydd Thomas1,2
1Macquarie University, Sydney, New South Wales, Australia.
Insights
Hypertrophic scarring affects over half of pediatric burn patients healing within 3 weeks, with 16.3% experiencing persistent scarring despite interventions. Early detection and management are crucial for burn scar outcomes.
Area of Science:
- Pediatric Burn Care
- Dermatology
- Wound Healing Research
Background:
- Hypertrophic scarring is a common and significant complication following burn injuries.
- The risk of hypertrophic scarring exists even for burns healing within 3 weeks, despite prophylactic interventions.
- Delayed wound healing (greater than 14 days) in partial thickness burns is a key factor.
Purpose of the Study:
- To determine the prevalence of early and persistent hypertrophic scarring in pediatric patients with partial thickness burns.
- To investigate the relationship between wound healing time and hypertrophic scar development.
- To assess the impact of conservative scar interventions on hypertrophic scarring outcomes.
Main Methods:
- Retrospective chart audit of 326 pediatric patients with partial thickness burns healed over 14 days without skin grafting.
- Data collected from 2014 to 2019 at a tertiary pediatric hospital.
- Hypertrophic scarring defined as >1mm height; early (3-6 months) and persistent (12-18 months) prevalence assessed.
Main Results:
- Median days to wound closure was 18 days.
- Early hypertrophic scarring prevalence was 56.1%, and persistent scarring was 16.3%.
- Over half of the children studied healed between 14 and 21 days, with significant scar prevalence at both early and persistent time points.
Conclusions:
- A substantial proportion of pediatric burn patients healing within 21 days develop hypertrophic scars.
- Even with interventions, persistent hypertrophic scarring remains a concern in this population.
- Children healing burns between 14 and 21 days require careful monitoring for hypertrophic scar development.
Abstract:
Hypertrophic scarring is a significant complication post burn injury, especially for delayed healing after 3 weeks. Burn injuries healing prior to 3 weeks also have the potential to develop hypertrophic scarring, even when prescribed prophylactic conservative scar interventions. A retrospective chart audit reviewed 326 burn patients treated at a paediatric tertiary hospital from 2014 to 2019 who sustained a partial thickness burn, healed >14 days and did not receive skin grafting. A scar was deemed hypertrophic if >1 mm in height. Early hypertrophic scar prevalence was defined as 3-6 months post burn, while persistent hypertrophic scarring was defined as 12-18 months post burn. Median days to wound closure was 18. The prevalence of early and persistent hypertrophic scarring was 56.1% and 16.3%, respectively. Seventeen (5.2%) children underwent medical interventions for scar modulation. Early signs of hypertrophic scarring were seen in just over half the patients presenting to burn therapy and despite scar intervention, persistent hypertrophic scarring was seen in 16.3%. At both time points, just over half of the children presenting healed between 14 and 21 days. Therefore, children healing prior to 21 days have potential to develop hypertrophic scarring.
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