Epidemiology and risk factors for Pathologic scarring after burn wounds

Objective: To describe the clinical characteristics of post-burn scars and determine the independent risk factors specific to these patients. While burns may generate widespread and disfiguring scars and have a dramatic influence on patient quality of life, the prevalence of post-burn pathologic scarring is not well documented, and the impact of certain risk factors is poorly understood. Methods: A retrospective analysis was conducted of the clinical records of 703 patients ( 2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of post-burn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing. Results: Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars ( 44%); 34, contractures ( 5%); and 196, hypertrophic-contracted scars ( 28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months ( median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for post-burn pathologic scarring ( Dxy 0.30). Conclusion: The identification of the principal risk factors for post-burn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.