Questions and Answers
What is the primary characteristic of hypertrophic scar tissue?
Raised, red, and rigid
What is the main reason for the excessive scar formation in hypertrophic scars?
Overproduction of collagen or dermal content
Which of the following populations is more prone to hypertrophic scars?
Dark-skinned population
What is the primary difference between normal skin and hypertrophic scar tissue in terms of collagen orientation?
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What is the main cause of functional and cosmetic problems in hypertrophic scars?
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What is the percentage of patients with deep second to third degree burns that are likely to develop hypertrophic scars?
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What is the primary characteristic that distinguishes keloids from hypertrophic scars?
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What is the typical timeline for the development of keloids?
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What is the primary factor that determines the likelihood of HTS formation?
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What is the primary difference in the dermal structure between keloids and hypertrophic scars?
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What is the primary reason why keloids are more prevalent in certain areas of the body?
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What is the typical time frame for hypertrophic scars to begin to appear?
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What is the purpose of inspecting a hypertrophic scar during management?
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What is the characteristic of chronic HTS in terms of color?
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What is the main difference between HTS and keloid?
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What is the significance of edema in a hypertrophic scar?
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What is a common problem associated with hypertrophic scars?
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How long does it typically take for a hypertrophic scar to fully mature?
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What is the method used to calculate the volume of a scar?
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What is the primary use of the Laser Doppler device?
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What is the purpose of using dental impression material?
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What is the advantage of using ultrasonography for scar assessment?
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What is a disadvantage of using the Laser Doppler device?
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What is one of the aspects of scar assessment that incorporates patient assessments?
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What is the primary characteristic of a mature scar in terms of tissue regularity?
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What is the highest score possible in the Vancouver Scar Scale?
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What is the primary advantage of the Modified Vancouver Scar Assessment Scale?
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What is the primary difference between the Patient Scar Assessment Scale and the Observer Scar Assessment Scale?
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What is the characteristic of a scar with a score of 3 in the Pliability category of the Vancouver Scar Scale?
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What is the characteristic of a scar with a score of 2 in the Height category of the Vancouver Scar Scale?
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Study Notes
Definition and Incidence of Hypertrophic Scars
- Hypertrophic scar (HTS) is a raised, red, rigid, and inflexible scar due to overproduction of collagen or dermal content within the wound boundaries.
- HTS occurs in more than 50% of patients with deep second- to third-degree burns (dermis involved).
- Higher incidence in children and dark-skinned population.
- More prevalent in chest, neck, lower face burns, and near joints, where skin tension is greater.
Mechanism of Hypertrophic Scar Formation
- Excessive deposition of fibroblast-derived extracellular matrix (ECM) proteins and especially collagen, over long periods, with persistent inflammation and fibrosis.
Characteristics of Hypertrophic Scars
- Acute (immature) HTS: red, raised, and rigid.
- Chronic (mature) HTS: pale, planner, and pliable.
- Scar maturation: 4-8 weeks to full scar maturation with non-hypertrophic healing; hypertrophic scars begin to appear 6 weeks – 3 months post-burn and peak between 3-6 months post-burn.
Associated Problems with Hypertrophic Scars
- Increased pain levels
- Contracture formation
- Loss of ROM
- Elevated anxiety levels
- Poor cosmoses
- Decreased health-related quality of life
Differentiation between Hypertrophic Scars and Keloids
- Hypertrophic scars: overproduction of collagen or dermal content within the boundaries of the wound.
- Keloids: overproduction of collagen or dermal content exceeding the boundaries of the wound.
- Keloids are more prevalent in chest, neck, lower face burns, and near joints, where skin tension is greater.
Assessment Tools for Hypertrophic Scars
- Inspection: color, height, edema, and site of injury.
- Palpation: temperature, height, and regularity of tissue.
- Vancouver Scar Assessment Scale: evaluates vascularity, pigmentation, pliability, and height.
- Modified Vancouver Scar Assessment Scale: abbreviated form of Vancouver scale, includes vascularity, pliability, and height.
- Patient and Observer Scar Assessment Scale (POSAS): measures scar quality from patient and clinician perspectives, includes subjective symptoms of pain and pruritus.
- Objective Assessment:
- Scar Volume: using dental impression material and syringe method.
- Vascularity of scar: using Laser Doppler device.
- Thickness of scar: using ultrasonography.
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