Challenging the Dogma

Abstract

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.

A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts

“…Several published studies consist of retrospective case note reviews where any documentation of a scar which is red or raised constitutes a diagnosis of HTS [5, 9]. Other studies use the height of the scar alone [10, 11] or VSS [12] to diagnose HTS. In addition, some papers consider hypertrophic scars alone whereas others combine HTS with contracted or keloid scars to give an overview of pathological scarring [13].…”

“…Thompson et al showed that HTS was more common in American Indian/Alaskan Native race (and also in TBSA >20% and facial burns) but were unable to identify the genetic variant responsible for this finding [12]. A recent study from the UK has failed to show a clear link between skin type and incidence of HTS, but this study included small numbers of non-white patients; just 18 of 181 patients had a Fitzpatrick skin type of 4 or above [11]. …”

Nanomedicine-based strategies to improve treatment of cutaneous leishmaniasis

“…The dysbiotic skin microbiota heighten skin inflammatory responses. When a wound becomes infected, and not properly treated, it takes significantly longer time to heal [132,133].…”

Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial

“…Burns that fully re-epithelialise before this point have a low risk of developing hypertrophic scars (and an especially low risk if healed within 2 weeks), whilst those requiring greater than 3 weeks are highly likely to scar. Although more recent research has somewhat challenged this doctrine by finding lower rates of scarring amongst the latter group than previously reported [32]—a change some authors attribute anecdotally to the increasing use of silver-impregnated dressings [31]—burns clinicians still overwhelmingly agree that prolonged healing is a major predictor for scar formation and regard any methods aimed at accelerating re-epithelisation as worthy of consideration.…”