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Title: Quantitative methods of cutaneous scar assessment
Author: Duncan, Jonathan A. L.
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2006
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Scars and scarring are fundamental issues for every surgical, burns and trauma patient. As such it is a phenomenon that we should be able to deal with in a simple and systematic fashion. However, at present there is no general agreement as to the most appropriate method or combination of methods, for scar assessment which will take account of all characteristics. This is important as there is a need for an accurate, objective and quantitative technique for scar assessment which will be able to assist in the diagnosis, monitoring and evaluation of the various scar management regimes available, as well as in the development of newer anti-scarring therapies. As part of two separate clinical trials investigating the scar improving efficacy of transforming growth factor beta 3 (TGFBeta3), the first section of this thesis investigates the use of Visual Analogue Scale scoring and Scar Ranking as a global scar assessment tool. Four thousand two hundred and ninety six photographic scar images were assessed by an external lay panel, using a newly devised computerized scar assessment system. The results obtained have shown the two methods to be consistent, reliable, feasible and truly valid in their assessments. Additionally, they were found to be highly sensitive and capable of measuring differences in scar quality. By comparing the Visual Analogue Scale scores of scar images with the associated clinical scar assessments, the Visual Analogue Scale scoring methodology was also found, not only to give a true representation of the clinical or ’biological’ reality of the scars, but to be superior to the more traditional forms of categorical scar scoring assessment. The second section of this thesis investigates instruments which objectively assess individual scar characteristics. Scars were assessed using: a SIAscope (for scar colour); a Visco-Elastic Skin Analyser - VESA, Reviscometer. Cutometer and Ballistometer (for scar mechanical properties); a Dermascan C ultra-sound (for scar volume); and a Phase shift Rapid In-vivo Measurement of Skin - PRIMOS (for scar surface characteristics). Each instrument was used to assess clinical characteristics of scars within the clinical trial. These scars were also assessed clinically and by the External Panel Visual Analogue Scale. The results obtained have shown each of the instruments to have a high level of sensitivity in the examination of the parameter for which they were intended, but that they do not, as individual tools, have the general discriminatory capacity as the Visual Analogue Scale as an overall scar assessment tool. In the search for an overall objective scar assessment methodology, the Visual Analogue Scale scar assessment, by an external panel, has been identified as today’s premier method. The assessor’s ability to integrate each characteristic of the scar, its severity, and relation to the scar type, results in a global integrated assessment of scar quality and appearance. The use of a panel of assessors adds to the objectivity of the assessment making the External Panel Visual Analogue Scale scoring methodology a robust, sensitive tool for the assessment of cutaneous scars.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available