Scar outcomes in children post burn healing with conservative management

This thesis investigates the prevalence and predictors of hypertrophic scarring in children who sustained a burn injury. It builds upon current literature, that increasing days to re-epithelisation is one of the most important factors associated with hypertrophic scar development. Recent literature suggests that wound healing occurring after 14 days may place the child at risk of hypertrophic scar development. Anecdotally, at the Children’s Hospital at Westmead, burn therapists have observed a percentage of patients conservatively managed and healing in >14 days develop hypertrophic scarring. 

Therefore, a retrospective medical record audit was conducted, surveying the outcomes of 326 children who had sustained a burn injury, were not skin grafted and healed in >14 days. Prevalence of hypertrophic scarring was identified at two time points: 3–6 months for early presence and 12–18 months for persistent hypertrophic scar. Healing times were divided into 14–21, 22–30 and >30 days, in order to identify patients scarring by healing time. Prevalence of hypertrophic scarring at 3–6 months was 56.1% and 16.3% at 12–18 months. 

Early hypertrophic scar monitoring, and where indicated initiation of prophylactic scar intervention, may be warranted for all children conservatively managed who heal in >14 days. To provide improved efficacy of individualized prophylactic scar interventions to this patient population, comparison of this intervention to no intervention until hypertrophic scar development or no intervention at all, needs to be conducted. Future research should also focus on defining a hypertrophic scar within a scar scale feasible for clinical use to improve reporting on prevalence and predictors of hypertrophic scarring.