TY - JOUR
T1 - Hypertrophic burn scar management
T2 - What does the evidence show? A systematic review of randomized controlled trials
AU - Friedstat, Jonathan S.
AU - Hultman, C. Scott
PY - 2014/6
Y1 - 2014/6
N2 - INTRODUCTION: Hypertrophic scars (HTS) are a source of morbidity for burn survivors and can present with a range of lifestyle-limiting problems. These include pruritus, pain, burning, stiffness, and contractures. Many solutions have been developed, but few have been studied in the form of a prospective, randomized control trial (RCT). Given the importance these RCTs carry in shaping the treatment of burn patients, we sought to systematically and critically review this portion of the burn literature. METHODS: PubMed was used to perform 2 separate searches with limits that included Humans, English, and Randomized Controlled Trial. A keyword search using "hypertrophic," "Scar," "burn," and "treatment" was cross-referenced with a MeSH subject-heading search using "Cicatrix, Hypertrophic" AND "Burn." Studies were then reviewed and excluded if they did not address management of burn HTS in the non-acute setting. RESULTS: Two literature searches resulted in a total of 32 articles. Twelve articles were excluded because they were not relevant to the topic (n = 10) or could not be obtained (n = 2). The remaining 20 articles contained 882 patients treated for hypertrophic scars. Breakdown based on topics included laser therapy (58 patients, 2 articles), silicone gel (204 patients, 7 articles), compression garment (236 patients, 4 articles), silicone + pressure (226 patients, 3 articles), topical emollients (58 patients, 2 articles), systemic therapy (62 patients, 1 article), intralesional therapy (18 patients, 1 article), and surgical treatment (20 patients, 1 article). While some articles had favorable conclusions (laser, emollients, surgical, and intralesional therapy) or unfavorable conclusions (systemic therapy), there were conflicting results on silicone and/or compression. CONCLUSIONS: Despite hypertrophic scars being a common occurrence in burn survivors, both the number of studies and consensus for treatment are limited. Efforts to perform larger, adequately powered RCTs are needed, specifically in the areas of silicone, compression garments, and combination therapy.
AB - INTRODUCTION: Hypertrophic scars (HTS) are a source of morbidity for burn survivors and can present with a range of lifestyle-limiting problems. These include pruritus, pain, burning, stiffness, and contractures. Many solutions have been developed, but few have been studied in the form of a prospective, randomized control trial (RCT). Given the importance these RCTs carry in shaping the treatment of burn patients, we sought to systematically and critically review this portion of the burn literature. METHODS: PubMed was used to perform 2 separate searches with limits that included Humans, English, and Randomized Controlled Trial. A keyword search using "hypertrophic," "Scar," "burn," and "treatment" was cross-referenced with a MeSH subject-heading search using "Cicatrix, Hypertrophic" AND "Burn." Studies were then reviewed and excluded if they did not address management of burn HTS in the non-acute setting. RESULTS: Two literature searches resulted in a total of 32 articles. Twelve articles were excluded because they were not relevant to the topic (n = 10) or could not be obtained (n = 2). The remaining 20 articles contained 882 patients treated for hypertrophic scars. Breakdown based on topics included laser therapy (58 patients, 2 articles), silicone gel (204 patients, 7 articles), compression garment (236 patients, 4 articles), silicone + pressure (226 patients, 3 articles), topical emollients (58 patients, 2 articles), systemic therapy (62 patients, 1 article), intralesional therapy (18 patients, 1 article), and surgical treatment (20 patients, 1 article). While some articles had favorable conclusions (laser, emollients, surgical, and intralesional therapy) or unfavorable conclusions (systemic therapy), there were conflicting results on silicone and/or compression. CONCLUSIONS: Despite hypertrophic scars being a common occurrence in burn survivors, both the number of studies and consensus for treatment are limited. Efforts to perform larger, adequately powered RCTs are needed, specifically in the areas of silicone, compression garments, and combination therapy.
KW - Burn
KW - Hypertrophic
KW - Hypertrophic burn scar treatment
KW - Scar
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=84901369173&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901369173&partnerID=8YFLogxK
U2 - 10.1097/SAP.0000000000000103
DO - 10.1097/SAP.0000000000000103
M3 - Article
C2 - 24835874
AN - SCOPUS:84901369173
SN - 0148-7043
VL - 72
SP - S198-S201
JO - Annals of plastic surgery
JF - Annals of plastic surgery
IS - SUPPL. 2
ER -