Abstract：
Scarring after burn injuries remains one of the major challenges in burn medicine and is the subject of current research. Accurate and high-quality assessment of scars is needed to enable exact outcome evaluation of different treatments. Our aim was to evaluate the most common subjective scar evaluation scores-the POSAS (Patient and Observer Scar Assessment Scale) and VSS (Vancouver Scar Scale)-in comparison with the objective device Mexameter® for colour evaluation.
A prospective monocentre study was performed, which included 120 examined scar areas of 60 patients with third degree burns who had received skin grafts between 1975 and 2018 with a total burned surface area (TBSA) > 2%. Two different scar areas in comparison with one healthy skin area concerning \'colour\', \'pigmentation\', and \'vascularization\' were evaluated by the Mexameter® MX 18, the OSAS, and the VSS by the same examiner, as well as the PSAS by the patient.
The mean TBSA of the 60 patients was 24.3%. In the OSAS, 61% of the scars were evaluated as \'hyper-\', 19% as \'hypo-\', and 19% as \'mix-pigmented\'. Furthermore, 65% of the scars were estimated as highly vascularized. In the Mexameter®, the melanin index values of the scar areas compared to the healthy skin areas showed a small difference of 12 (p < 0.05). The mean difference of erythema between the scar and the healthy skin areas was 84 (p < 0.001). For the Mexameter®, moderate correlations were found when comparing \'erythema\' with the OSAS category \'vascularization\' (r = 0.33, p < 0.05) and \'melanin\' with the OSAS parameter \'pigmentation\' (r = 0.28, p < 0.05). When comparing the Mexameter® measurements to the OSAS questionnaire, 27% of the scars were wrongly evaluated as \'hyperpigmented\' by the observer and 21% as \'hypervascularized\', while showing low measurements in the device. Additionally, a novel Mexameter® ordinal scare scale was calculated.
In this study, we were able to show on a relatively large patient population that with the Mexameter®, the subjectivity of the scar colour assessment by examiner/patient can be overcome, but precise differentiation can still be ensured with subjective evaluation tools. We further introduced a novel Mexameter® Scar Scale. It is necessary to further investigate the vast range of objective devices and develop scar panels for with an incorporation of objective and subjective devices to further improve reliability with reduced bias in terms of scar assessment.
A prospective monocentre study was performed, which included 120 examined scar areas of 60 patients with third degree burns who had received skin grafts between 1975 and 2018 with a total burned surface area (TBSA) > 2%. Two different scar areas in comparison with one healthy skin area concerning \'colour\', \'pigmentation\', and \'vascularization\' were evaluated by the Mexameter® MX 18, the OSAS, and the VSS by the same examiner, as well as the PSAS by the patient.
The mean TBSA of the 60 patients was 24.3%. In the OSAS, 61% of the scars were evaluated as \'hyper-\', 19% as \'hypo-\', and 19% as \'mix-pigmented\'. Furthermore, 65% of the scars were estimated as highly vascularized. In the Mexameter®, the melanin index values of the scar areas compared to the healthy skin areas showed a small difference of 12 (p < 0.05). The mean difference of erythema between the scar and the healthy skin areas was 84 (p < 0.001). For the Mexameter®, moderate correlations were found when comparing \'erythema\' with the OSAS category \'vascularization\' (r = 0.33, p < 0.05) and \'melanin\' with the OSAS parameter \'pigmentation\' (r = 0.28, p < 0.05). When comparing the Mexameter® measurements to the OSAS questionnaire, 27% of the scars were wrongly evaluated as \'hyperpigmented\' by the observer and 21% as \'hypervascularized\', while showing low measurements in the device. Additionally, a novel Mexameter® ordinal scare scale was calculated.
In this study, we were able to show on a relatively large patient population that with the Mexameter®, the subjectivity of the scar colour assessment by examiner/patient can be overcome, but precise differentiation can still be ensured with subjective evaluation tools. We further introduced a novel Mexameter® Scar Scale. It is necessary to further investigate the vast range of objective devices and develop scar panels for with an incorporation of objective and subjective devices to further improve reliability with reduced bias in terms of scar assessment.
摘要：
背景：烧伤后的疤痕仍然是烧伤医学的主要挑战之一，并且是当前研究的主题。需要对疤痕进行准确和高质量的评估，以实现对不同治疗方法的准确结果评估。我们的目的是评估最常见的主观疤痕评估评分-POSAS（患者和观察者疤痕评估量表）和VSS（温哥华疤痕量表）-与用于颜色评估的客观设备Mexameter®进行比较。
方法：进行了前瞻性单中心研究，其中包括在1975年至2018年期间接受皮肤移植的60例三度烧伤患者的120例检查瘢痕区域,烧伤总表面积(TBSA)>2%.与一个健康皮肤区域相比，两个不同的疤痕区域涉及“颜色”，\'色素沉着\',和“血管化”由Mexameter®MX18、OSAS、和同一考官的VSS，以及患者的PSAS。
结果：60例患者的TBSA平均值为24.3%。在OSAS,61%的伤疤被评估为“超”，19%作为\'次-\'，19%为“混合色素”。此外，估计65%的疤痕是高度血管化的。在Mexameter®中，与健康皮肤区域相比，疤痕区域的黑色素指数值显示出12的小差异（p<0.05）。瘢痕和健康皮肤区域之间红斑的平均差异为84(p<0.001)。对于Mexameter®，当比较“红斑”与OSAS类别“血管化”（r=0.33，p<0.05）和“黑色素”与OSAS参数“色素沉着”（r=0.28，p<0.05）时，发现中度相关性。在将Mexameter®测量值与OSAS问卷进行比较时，27％的疤痕被观察者错误地评估为“色素沉着过度”，21％被错误地评估为“血管过度化”，同时显示设备中的低测量值。此外,计算了一个新的Mexameter®序数恐慌量表。
结论：在这项研究中，我们能够在相对较大的患者人群中证明，使用Mexameter®，可以克服检查者/患者对疤痕颜色评估的主观性，但是主观评估工具仍然可以确保精确的区分。我们进一步介绍了一种新颖的Mexameter®疤痕秤。有必要进一步研究各种客观设备，并开发包含客观和主观设备的疤痕面板，以进一步提高可靠性，并减少疤痕评估方面的偏见。
方法：进行了前瞻性单中心研究，其中包括在1975年至2018年期间接受皮肤移植的60例三度烧伤患者的120例检查瘢痕区域,烧伤总表面积(TBSA)>2%.与一个健康皮肤区域相比，两个不同的疤痕区域涉及“颜色”，\'色素沉着\',和“血管化”由Mexameter®MX18、OSAS、和同一考官的VSS，以及患者的PSAS。
结果：60例患者的TBSA平均值为24.3%。在OSAS,61%的伤疤被评估为“超”，19%作为\'次-\'，19%为“混合色素”。此外，估计65%的疤痕是高度血管化的。在Mexameter®中，与健康皮肤区域相比，疤痕区域的黑色素指数值显示出12的小差异（p<0.05）。瘢痕和健康皮肤区域之间红斑的平均差异为84(p<0.001)。对于Mexameter®，当比较“红斑”与OSAS类别“血管化”（r=0.33，p<0.05）和“黑色素”与OSAS参数“色素沉着”（r=0.28，p<0.05）时，发现中度相关性。在将Mexameter®测量值与OSAS问卷进行比较时，27％的疤痕被观察者错误地评估为“色素沉着过度”，21％被错误地评估为“血管过度化”，同时显示设备中的低测量值。此外,计算了一个新的Mexameter®序数恐慌量表。
结论：在这项研究中，我们能够在相对较大的患者人群中证明，使用Mexameter®，可以克服检查者/患者对疤痕颜色评估的主观性，但是主观评估工具仍然可以确保精确的区分。我们进一步介绍了一种新颖的Mexameter®疤痕秤。有必要进一步研究各种客观设备，并开发包含客观和主观设备的疤痕面板，以进一步提高可靠性，并减少疤痕评估方面的偏见。
