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Ezio Nicola Gangemi, MD; Dario Gregori, MA, PhD; Paola Berchialla, PhD; Enrico Zingarelli, MD; Monica Cairo, MD; Daniele Bollero, MD; Jamal Ganem, MD; Roberto Capocelli, MD; Franca Cuccuru, MD; Pompeo Cassano, MD; Daniela Risso, MD; Maurizio Stella, MD

Arch Facial Plast Surg. 2008;10(2):93-102.

Objective  To describe the clinical characteristics of postburn 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 postburn 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 postburn 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 postburn pathologic scarring (Dxy 0.30).

Conclusion  The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.

Author Affiliations: Department of Plastic and Reconstructive Surgery, Burn Center, Traumatological Center (Drs Gangemi, Zingarelli, Cairo, Bollero, Ganem, Capocelli, Cuccuru, Cassano, Risso, and Stella), and Department of Public Health and Microbiology, University of Turin (Drs Gregori and Berchialla), Turin, Italy.