Summary
Introduction
Evaluation tools are used to quantify scar evolution and determine treatment effectiveness.
In clinical practice, scar assessment scales are less costly, tend to cover a greater
number of aspects related to scar characteristics and can incorporate a patient's
opinion in the assessment. However, the scales have not yet been used as an evaluation
method for the postoperative recurrence of keloids.
Objective
The study aims to evaluate the effectiveness of scar rating scales for keloid recurrence
after surgical excision.
Methods
Patients (n = 25) with keloids on the trunk were treated by surgical resection and postoperative
beta radiation therapy. On the 3rd, 6th, 9th and 12th postoperative months, two specialists
classified the lesions qualitatively in recurrent and non-recurrent cases. Furthermore,
in the objective evaluation, the items on the Seattle Scar Scale (SSS) and the Stony
Brook Scar Evaluation Scale (SBSES) were assessed by specialists, and the patients
assessed items on the Patient Scar Assessment Scale (PSAS) for the pre- and postoperative
periods. The scars were classified qualitatively as “good” or “poor.”
Results
Recurrence was observed in 18 patients (72%), according to the specialists' qualitative
assessments. The best scores on the SSS and SBSES were given to the non-recurrent
(p < 0.001) scars. The highest PSAS values were for the scars classified as “poor” (p < 0.001). There were no differences in the PSAS values for the preoperative period
and outcomes for the recurrent scars (p = 0.519). The outcomes showed that the non-recurrent scars had lower values on the
PSAS compared to the recurrent scars (p = 0.001) and compared to the preoperative period (p = 0.004).
Conclusions
The PSAS, SSS and SBSES scales were effective methods in distinguishing keloid postoperative
recurrence. It is necessary to establish the recurrence cut-off scores for each of
the scales according to the treatment used.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Keloids: current concepts of pathogenesis (review).Int J Mol Med. 2009; 24: 283-293
- Control of the skin scarring response.Acad Bras Cienc. 2009; 81: 623-629
- Nerve fibers: a possible role in keloid pathogenesis.Br J Dermatol. 2008; 158: 651-652
- Levels of evidence for the treatment of keloid disease.J Plast Reconstr Aesthet Surg. 2008; 61: 4-17
- The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study.Plast Reconstr Surg. 2007; 119: 2248-2254
- A critical analysis of measurements used to assess and manage scars.Int J Low Extrem Wounds. 2007; 6: 249-253
- Burn scar assessment: a systematic review of different scar scales.J Surg Res. 2010; 164: e115-e123
- A review of scar scales and scar measuring devices.Eplasty. 2010; 10: e43
- Rating the burn scar.J Burn Care Rehabil. 1990; 11: 256-260
- The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation.Plast Reconstr Surg. 2004; 113: 1960-1965
- What factors affect the quality of life of patients with keloids?.Rev Assoc Med Bras. 2009; 55: 700-704
- The Patient Scar Assessment Questionnaire: a reliable and valid patient-reported outcomes measure for linear scars.Plast Reconstr Surg. 2009; 123: 1481-1489
- The modified Patient and Observer Scar Assessment Scale: a novel approach to defining pathologic and nonpathologic scarring.Plast Reconstr Surg. 2011; 127: 242-247
- Improved burn scar assessment with use of a new scar-rating scale.J Burn Care Rehabil. 1997; 18: 353-355
- Development and validation of a novel scar evaluation scale.Plast Reconstr Surg. 2007; 120: 1892-1897
- The hidden cost of skin scars: quality of life after skin scarring.J Plast Reconstr Aesthet Surg. 2008; 61: 1049-1058
- Current tools for noninvasive objective assessment of skin scars.Plast Reconstr Surg. 2010; 126: 912-923
- Radiation therapy following keloidectomy: a 20-year experience.Int J Radiat Oncol Biol Phys. 1989; 17: 77-80
- Treatment of keloids by combined surgical excision and immediate postoperative X-ray therapy.Ann Plast Surg. 1981; 7: 281-285
- The surgical treatment of keloids.Plast Reconstr Surg. 1961; 27: 335-358
- Treatment of keloids with excision and postoperative X-ray irradiation.Dermatologica. 1983; 167: 90-93
- Treatment of keloids with surgical excision and postoperative X-ray radiation.Scand J Plast Reconstr Surg Hand Surg. 1989; 23: 211-215
- Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external radiation.Radiother Oncol. 2004; 73: 233-236
- Radiotherapy in the treatment of keloids in East Africa.East Afr Med J. 1973; 50: 457-461
- Results of prophylactic irradiation in patients with resected keloids–a retrospective analysis.Acta Oncol. 2000; 39: 217-220
- Radiotherapy for keloid treatment.J Natl Med Assoc. 1973; 65: 71-75
- Prevention and treatment of earlobe keloids.Ann Plast Surg. 1982; 9: 264-265
- Single-dose electron beam irradiation in treatment and prevention of keloids and hypertrophic scars.Radiother Oncol. 1990; 19: 267-272
- Skin scar preconceptions must be challenged: importance of self-perception in skin scarring.J Plast Reconstr Aesthet Surg. 2010; 63: 1022-1029
- Changes in subjective vs objective burn scar assessment over time: does the patient agree with what we think?.J Burn Care Rehabil. 2003; 24: 239-244
Article info
Publication history
Published online: March 05, 2012
Accepted:
February 4,
2012
Received:
June 4,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
