Reviews on scar evaluation

Vercelli et al. 2009 Disability and Rehabilitation; 31(25): 2055-2063

‘To date, VSS is the most widely used rating scale but POSAS appears the most comprehensive, taking into account the important aspect of patient’s perspective.’

Falder et al. 2009 Burns Aug;35(5):618-41

‘Despite its limitations, the Vancouver Scar Scale is widely used and recognized by therapists working in the burns setting. However, overall the POSAS appears the best tool.’

Idris et al. 2009 Skin Research and Technology; 15: 1-5

‘Comparing the VSS, the most frequently used scar assessment scale to date, to the Patient and Observer Scar Assessment Scale, both were found to be valid. However, the POSAS was found to be more consistent reliable and feasible making it a useful subjective evaluation tool.’

Van der Wal et al. 2011. Journal of Burn Care and Research (submitted)

‘To date, many authors consider the POSAS most suitable for scar assessment as it includes a comprehensive list of frequently used scar features, incorporated a patients’ opinion and has a superior internal consistency and reliability compared to the VSS.’

Clinimetric studies concerning the POSAS

Draaijers et al. 2004 Plast Reconstr Surg

(Draaijers, LJ, Tempelman, FR, Botman, YA, Tuinebreijer, WE, Middelkoop, E, Kreis, RW, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113:1960-1965; discussion 1966-1967.)
– ‘The (internal) consistency of both the patient and the Observer Scales was acceptable (Cronbach’s alpha, 0.76 and 0.69, respectively), whereas the consistency of the Vancouver scale appeared not to be acceptable (alpha, 0.49)’
– ‘The reliability of the Observer Scale completed by a single observer was acceptable (r=0.73).’
– ‘Linear regression of the general opinions on scars of the observers and the patient showed that the observer’s opinion is influenced by vascularization, thickness, pigmentation, and relief, whereas the patient’s opinion is mainly influenced by itching and the thickness of the scar.’
– ‘The Patient and Observer Scar Assessment Scale offers a suitable, reliable, and complete scar evaluation tool.’

Van de Kar et al. 2005 Plast Reconstr Surg.

(Van de Kar, AL, Corion, LU, Smeulders, MJ, Draaijers, LJ, van der Horst, CM, van Zuijlen, PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg. 2005;116:514-522.)
– ‘The internal consistency of the observer and Patient Scales was good (Cronbach’s α = 0.86 and 0.90, respectively).’
– ‘The reliability of the Observer Scale was good for the Total Score (r= 0.96, p < 0.001) and separate items(r≥ 0.86, p < 0.001) for three observers.’
– ‘Even a single observer evaluated scars reliably with respect to the Total Score (r= 0.88, p< 0.001) and the items vascularity, pigmentation, thickness, and surface area (r> 0.70, p< 0.001).’
– ‘The patients’s intraobserver reliability was good for the Total Score (r= 0.94, p< 0.001) and separate items (r= 0.89, p<0.001).
– ‘The Patient and Observer Scar Assessment Scale is an appropriate subjective tool for the evaluation of linear scars.’

Truong et al. 2007 Plast Reconstr Surg.

(Truong, PT, Lee, JC, Soer, B, Gaul, CA, Olivotto, IA. Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery. Plast Reconstr Surg. 2007;119:487-494.)
– ‘The observer tool and Vancouver scale correlated significantly with each other (p< 0.001), but only the observer tool correlated well with patients’ ratings (p= 0.04).
– ‘The new tool is more comprehensive and has higher correlations with patient’s ratings. These findings support the use of the new tool as a reliable, valid, and comprehensive approach to assess linear scars.’

Van der Wal et al. 2011 Quality of life Research (Submitted)

Psychometric properties of the POSAS were examined using Rasch analysis.
‘Cross-sectional data collection from seven clinical trials resulted in a dataset of 1629 observer scores and 1427 patient scores of burn scars’… ‘The Rasch model demonstrated that the POSAS is a reliable scale that measures the single construct scar quality.’

Studies that used the POSAS for scar evaluation

– Kava, BR, Ayyathurai, R, Soloway, CT, Suarez, M, Kanagarajah, P, Murugesan, M. Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions. Indian J Urol. 2010;26:345-349.
– Khoo, TL, Halim, AS, Zakaria, Z, Mat Saad, AZ, Wu, LY, Lau, HY. A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars. J Plast Reconstr Aesthet Surg. 2010.
– Dziegielewski, PT, O’Connell, DA, Rieger, J, Harris, JR, Seikaly, H. The lip-splitting mandibulotomy: aesthetic and functional outcomes. Oral oncology. 2010;46:612-617.
– Aust, MC, Fernandes, D, Kolokythas, P, Kaplan, HM, Vogt, PM. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg. 2008;121:1421-1429
– Bianchi, FA, Roccia, F, Fiorini, P, Berrone, S. Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel. The Journal of craniofacial surgery. 2010;21:719-723.
– O’Connell, DA, Diamond, C, Seikaly, H, Harris, JR. Objective and subjective scar aesthetics in minimal access vs conventional access parathyroidectomy and thyroidectomy surgical procedures: a paired cohort study. Archives of otolaryngology–head & neck surgery. 2008;134:85-93.
– Sardesai, MG, Moore, CC. Quantitative and qualitative dermal change with microfat grafting of facial scars. Otolaryngol Head Neck Surg. 2007;137:868-872.
– van de Kar, AL, Kreulen, M, van Zuijlen, PP, Oldenburger, F. The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study. Plast Reconstr Surg. 2007;119:2248-2254.
– Nipshagen, MD, Hage, JJ, Beekman, WH. Use of 2-octyl-cyanoacrylate skin adhesive (Dermabond) for wound closure following reduction mammaplasty: a prospective, randomized intervention study. Plastic and reconstructive surgery. 2008;122:10-18.
– Kaartinen, IS, Valisuo, PO, Alander, JT, Kuokkanen, HO. Objective scar assessment–a new method using standardized digital imaging and spectral modelling. Burns. 2010;37:74-81.
– Cromi, A, Ghezzi, F, Gottardi, A, Cherubino, M, Uccella, S, Valdatta, L. Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. American journal of obstetrics and gynecology. 2010;203:36 e31-38.
– Zaal, LH, van der Horst, CM. Results of the early use of tissue expansion for giant congenital melanocytic naevi on the scalp and face. J Plast Reconstr Aesthet Surg. 2009;62:216-220.
– Zaal, LH, Mooi, WJ, Sillevis Smitt, HJ. Results of early currettage of giant congenital melanocytic nevi; a report of eight cases and a review of the literature. Euro J Plast Surg 2008 30:257-262.