Keywords

scar aesthetics, digital imaging and scars

Authors

1. Valente, Jonathan H. MD
2. Jay, Gregory D. MD, PhD
3. Schmidt, Scott T. MD
4. Oh, Albert K. MD
5. Reinert, Steven E. MS
6. Zabbo, Christopher P. DO

ABSTRACT

OBJECTIVE: Aesthetic outcome is an important end point of wound care. The purpose of this study was to compare a wound aesthetic scoring system by emergency physicians, patients, and digital imaging by blinded plastic surgeons. The goal was to see if digital photography could accurately analyze the aesthetics of closed lacerations for future research.

METHODS: This was a subanalysis of a prospective, randomized trial conducted in an urban, academic emergency department. Patients aged 18 to 100 years were included if they had simple, uncomplicated lacerations 8 hours old or less located on the trunk, head or neck (not scalp), or extremities that required repair by sutures. Exclusion criteria included immunocompromised state of health, a complicated laceration, specialty consultant intervention in management of the wound, or current use of or need for antibiotics for wound prophylaxis. Complicated lacerations were defined in the article. Infection outcomes, demographics, and aesthetic outcomes were assessed. Scar appearance was assessed at 3 to 4 months after closure using a previously validated 0-to 100-mm visual analog scale (VAS) score and 6-point wound evaluation score (WES) done by 2 trained emergency physicians (MD1 and MD2). Patients also performed self-VAS (VAS_Pt), whereas VAS was done using digital imaging by 2 trained plastic surgeons (VAS_Plast1 and VAS_Plast2). Data were evaluated when both plastic surgeons independently believed that the digital images were able to be adequately scored. Pearson correlation coefficients were performed using mean values.

RESULTS: Three-to 4-month VAS_MD and WES_MD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VAS_Pt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS_Plast in 34 of 66 (51.5%). Mean scores for VAS_MD1 and VAS_MD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES_MD1 and WES_MD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS_Pt were 86.6 (SD, 16.6) mm. Mean scores for VAS_Plast1 and VAS_Plast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS_MD1 and VAS_MD2 (r = 0.63; n = 34; P < .001), WES_MD1 and WES_MD2 (r = 0.70; n = 34; P < .001), and VAS_Plast1 and VAS_Plast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS_MD and VAS_Plast (r = 0.56; n = 34; P < .001), VAS_Pt and WES_MD (r =0.60; n = 34; P < .001), and VAS_MD and WES_MD (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS_Pt and VAS_Plast at r = 0.25 (n = 34; P = .16), VAS_Pt and VAS_MD at r = 0.37 (n = 34; P =.03), and WES_MD and VAS_Plast at r = 0.13 (n = 34; P =.45).

Three-to 4-month VAS_MD and WES_MD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VAS_Pt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS_Plast in 34 of 66 (51.5%). Mean scores for VAS_MD1 and VAS_MD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES_MD1 and WES_MD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS_Pt were 86.6 (SD, 16.6) mm. Mean scores for VAS_Plast1 and VAS_Plast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS_MD1 and VAS_MD2 (r = 0.63; n = 34; P < .001), WES_MD1 and WES_MD2 (r = 0.70; n = 34; P < .001), and VAS_Plast1 and VAS_Plast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS_MD and VAS_Plast (r = 0.56; n = 34; P < .001), VASPt and WES_MD (r =0.60; n = 34; P < .001), and VAS_MD and WES_MD (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS_Pt and VAS_Plast at r = 0.25 (n = 34; P = .16), VAS_Pt and VAS_MD at r = 0.37 (n = 34; P =.03), and WES_MD and VAS_Plast at r = 0.13 (n = 34; P =.45).

Three-to 4-month VAS_MD and WES_MD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VAS_Pt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS_Plast in 34 of 66 (51.5%). Mean scores for VAS_MD1 and VAS_MD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES_MD1 and WES_MD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS_Pt were 86.6 (SD, 16.6) mm. Mean scores for VAS_Plast1 and VAS_Plast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS_MD1 and VAS_MD2 (r = 0.63; n = 34; P < .001), WES_MD1 and WES_MD2 (r = 0.70; n = 34; P < .001), and VAS_Plast1 and VAS_Plast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS_MD and VAS_Plast (r = 0.56; n = 34; P < .001), VASPt and WES_MD (r =0.60; n = 34; P < .001), and VAS_MD and WES_MD (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS_Pt and VAS_Plast at r = 0.25 (n = 34; P = .16), VAS_Pt and VAS_MD at r = 0.37 (n = 34; P =.03), and WES_MD and VAS_Plast at r = 0.13 (n = 34; P =.45).

CONCLUSIONS: Correlations were moderate for VAS_MD and VAS_Plast; however, correlations were weak for VAS_Pt and VAS_Plast, VAS_Pt and VAS_MD, and WES_MD and VAS_Plast. This small study assessing digital imaging as a tool for evaluating scar aesthetics demonstrated limitations in its use. Future studies with larger populations and improved imaging modalities, such as 3-dimensional cameras and high-dynamic-range imaging, may provide potential for better assessment.