Long-term scar quality in burns with three distinct healing potentials: a multicenter prospective cohort study

Harold Goei, Cornelis H van der Vlies, M Jenda Hop, Wim E Tuinebreijer, Marianne K Nieuwenhuis, Esther Middelkoop, Margriet E van Baar

Research output: Contribution to journalArticleAcademicpeer-review


The laser Doppler imager is used in cases of indeterminate burn depth to accurately predict wound healing time at an early stage. The laser Doppler imager classifies burns into three estimated healing potentials as follows: high, <14 days; intermediate, 14-21 days; and low, >21 days. At this time, the relationship between these healing potentials and long-term scar quality is unknown. The objective of this study was to determine the long-term scar quality of burns with three distinct healing potentials. The secondary objectives were to compare treatment strategies in intermediate wounds, to study the effect of the timing of surgery on low healing potential wounds and to identify predictors of reduced scar quality. Hence, in a prospective cohort study, scar quality was determined in patients whose burns were assessed with laser Doppler imaging. Scar Quality was assessed with objective and subjective measurement tools, including overall scar quality (Patient and Observer Scar Assessment Scale) as a primary outcome and color and elasticity parameters. A total of 141 patients (>19 months postburn) with 216 scars were included. Wounds with high and intermediate healing potential did not significantly differ regarding scar quality. Wounds with a low healing potential had a significantly lower scar quality. Analysis of 76 surgically treated low healing potential wounds showed no significant differences in the primary outcome regarding the timing of surgery (≤14 days vs. >14). Predictors of reduced long-term scar quality were darker skin type and multiple surgeries. In conclusion, scar quality was strongly related to the healing potential category. Scar quality was very similar in high and intermediate healing potential wounds. No positive effects were found on scar quality or on healing time in surgically treated wounds with intermediate healing potential, advocating a conservative approach. Further studies should focus on the optimal timing of surgery in low healing potential wounds.

Original languageEnglish
Pages (from-to)721-730
Number of pages10
JournalWound Repair and Regeneration: The International Journal of Tissue Repair and Regeneration
Issue number4
Publication statusPublished - 2016
Externally publishedYes


  • age groups
  • burns
  • diagnostic imaging
  • cicatrix
  • analysis of variance
  • laser-doppler flowmetry
  • color
  • elasticity (physiology)
  • imaging techniques
  • prognosis
  • skin
  • physiology
  • scars
  • time factors
  • wound healing


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