Evaluating scar outcomes in pediatric patients with burns after skin grafting

Scarring and its long-term sequelae, contribute significantly to morbidity following burn injuries. Factors associated with less favourable scar outcomes include the depth of burn, younger age, pigmented skin types and prolonged healing times. The aim of primary burn surgery is to debride non-viable tissue, to enable healing. However, international consensus regarding the optimal timing for debridement and grafting in pediatric patients with burns is lacking. Delayed wound healing is thought to increase the risk of poor scar quality, however, the evidence for this is weak with few studies investigating long-term outcomes in pediatric patients. The aim of this study, therefore, was to investigate the effect of patient and treatment factors on scar quality, one year after skin grafting in pediatric patients with burns. Patient factors included age, skin type, and site of burn, while treatment factors included timing of surgery, type of surgery, and healing times. Pediatric patients (age <18 years) presenting to a National Burn Unit from 2011 until 2020, inclusive were considered for inclusion in the study. Burn injuries between 1% and 14.9% total body surface area (TBSA) and who required skin grafting for the primary treatment of their burn, were included. Patients who failed to attend their 12-month follow-up visit were excluded. Standardised clinical photographs were assessed using a modified version of the Patient and Observer Scar Assessment Scale, version 2.0 (POSAS). Thirty children (median age 3.9 years) were included. Factors with an independent effect on higher (worse) POSAS scores were younger age at the time of injury (p<0.001), body site of the trunk (p<0.002), or the lower extremity (p<0.001) and a longer duration of healing time after skin grafting (p=0.003). The duration of time between injury and surgery was not an independent factor for POSAS scores (p=0.56). We had insufficient numbers to discriminate differences in scar quality for different graft types; meshed versus non-meshed. In this study, we found that long-term scar outcomes in pediatric burn patients after skin grafting were worse for those injured at a younger age, with burns on the trunk or lower extremity, or with prolonged healing time after grafting. The robustness of this conclusion is limited by the small sample size of the study cohort and by our use of photographic scar assessment .