Burns objective scar scale (BOSS): Validation of an objective measurement devices based burn scar scale panel

AimsHypertrophic scars in burn survivors are a major cause of morbidity but the development of evidence based treatments is hampered by the lack of objective measurements of these scars. The objective of our study is to investigate the most accurate parameters for objective scar assessment and to create a combination score to facilitate the use of a panel of objective scar measurement tools.MethodsThree independent assessors evaluated fifty five scar sites on fifty five burn patients with both the subjective modified Vancouver Scar Scale (mVSS) and a panel of objective measurement tools including the DSM II Colormeter, Cutometer, Dermascan high frequency ultrasound. The sensitivity and specificity of the objective scar parameters in predicting a mVSS score of 6 or more using the Receiving Operator Characteristic Area under the curve (ROC AUC) was then calculated and the most accurate parameters were combined to create an objective global scar score.ResultsThe ROC AUC values were found to be highest for the Dermascan scar thickness (0.897), dermal intensity and intensity ratio (0.914 and 0.919), Cutometer R0 value (0.942), and R0 ratio (0.944). For colour measurements, ratios of scar to normal skin performed better than the single parameters for both erythema and pigmentation measurements: DSM II Erythema ratio vs Erythema (0.885 vs 0.818), DSM II a* ratio vs a* (0.848 vs 0.741); DSM II Melanin ratio vs Melanin (0.854 vs 0.761), DSM II L* ratio vs L* (0.862 vs 0.767). Analysis of the ROC AUC with chi-square test values showed that the highest AUC (0.786) was obtained with the combination of the Cutometer R0, Dermascan scar thickness, intensity and their respective scar to normal skin ratios. A total score of 5 and above (out of 6 parameters) had the highest combined sensitivity (69.0%) and specificity (83.3%).ConclusionThe objective parameters for the DSM II Colormeter, Cutometer and Dermascan high frequency ultrasound were all found to have moderate to strong ROC AUC values and combination of the Cutometer R0 and Dermascan scar thickness and intensity values can be used to create an objective global scar scale that can accurately differentiate patients with hypertrophic burn scarring from non-hypertrophic scars or normal skin.     

A modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA): Inter-rater reliability of an innovative burn scar assessment method

Background

Current scar assessment methods do not capture variation in scar outcome across the burn scar surface area. A new method (mVSS-TBSA) using a modified Vancouver Scar Scale (mVSS) linked with %TBSA was devised and inter-rater reliability was assessed.

Method

Three raters performed scar assessments on thirty patients with burn scars using the mVSS-TBSA. Scoring on pigmentation, vascularity, pliability and height was undertaken for the ‘best’ and ‘worst’ areas of each scar. Raters allocated the total body surface area of the scar (%TBSA) to three mVSS categories (<5, 5–10, >10). Intra-class correlation coefficient (ICC) and weighted kappa statistic (k_w) were used to assess inter-rater reliability. The data were also analysed for clinically relevant misclassifications between pairs of raters.

Results

Total mVSS scores showed ‘fair to good’ agreement (ICC 0.65–0.73) in the ‘best’ area of the scar while there was ‘excellent’ agreement in the ‘worst’ scar area (ICC 0.85–0.88). The k_w of the individual mVSS components ranged from 0.44 to 0.84 and 0.02 to 0.86 for ‘best’ and ‘worst’ scar areas, respectively. Determination of scar %TBSA had ‘excellent’ reliability (ICC 0.91–0.96). Allocation of scar %TBSA to severity category <5 mVSS demonstrated ‘good to excellent’ reliability (ICC 0.63–0.80) and ‘fair to good’ reliability (ICC 0.42–0.74) for 5–10 mVSS category. However, misclassifications were observed for the total mVSS score in the ‘worst’ scar area and the allocation of scar %TBSA in the <5 mVSS category.

Conclusion

Inter-rater reliability of mVSS scores depends on the severity of the scar area being assessed. The mVSS-TBSA method of allocation of scar %TBSA to two broad mVSS categories, namely <5 and ≥5 mVSS, has ‘good to excellent’ reliability. The mVSS-TBSA has demonstrated utility for both clinical and research purposes; however, there is potential to misclassify scar outcome in some cases.     

Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars

BackgroundHypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars.MethodsForty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO₂ laser and fractional ablative CO₂ laser group (group 1, n = 20) or fractional ablative CO₂ laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed.ResultsForty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05).ConclusionEffective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.     

Genetic influence on scar height and pliability after burn injury in individuals of European ancestry: A prospective cohort study

After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium^® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic model adjusting for age, sex, number of surgical procedures and % total body surface area of burn in subjects of European ancestry. No individual genetic variants achieved the cut-off threshold of significance. Gene regions were analysed for spatially correlated single nucleotide polymorphisms and significant regions identified using comb-p software. This gene list was subject to gene pathway analysis to find which biological process terms were over-represented. Using this approach biological processes related to the nervous system and cell adhesion were the predominant gene pathways associated with both SH and SP. This study suggests genes associated with innervation may be important in scar fibrosis. Further studies using similar and larger datasets will be essential to validate these findings.     

Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment

IntroductionIn line with other researchers in the field of burns’ care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds.MethodChildren aged six months – six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers.ResultsOf the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days.ConclusionsThis study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.     

A comparison on the scar development when done through overlapping versus approximating seams techniques — A clinical trial

IntroductionSkin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting.ObjectiveWe sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars.Methods and materialsPatients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the “approximating” technique and the other side was fixed by the “overlapping” technique with a 1–2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant.ResultsThirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001).ConclusionWe compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.     

Incorporation of 3D stereophotogrammetry as a reliable method for assessing scar volume in standard clinical practice

Significant disfigurement and dysfunction is caused by hypertrophic scarring, a prevalent complication of burn wounds. A lack of objective tools in the assessment of scar parameters makes evaluation of scar treatment modalities difficult. 3D stereophotogrammetry, obtaining measurements from 3D photographs, represents a method to quantitate scar volume, and a 3D camera may have use in clinical practice. To validate this method, scar models were created and photographed with a 3D camera. Measurements from 3D image analysis of these scar models were compared to physical measurements of scar model volume. Reliability of 3D image analysis was assessed with both scar models and burn patient scars. Measurements of scar models by two independent observers were compared to determine inter-rater reliability, and measurements from 3D images of burn patient hypertrophic scars were compared to determine the consistency of the method between observers. The time taken for patient photography was recorded. No significant differences were found between the two methods of volume calculation (p = 0.89), and a plot of the differences showed agreement between the methods. The correlation coefficient between the two observers’ measurements of scar model volume was 0.92, and the intra-class correlation coefficient for patient scar volume was 0.998, showing good reliability. The time required to capture 3D photographs ranged from 2 to 6 min per patient, showing the potential for this tool to be efficiently incorporated into clinical practice. 3D stereophotogrammetry is a valid method to reliably measure scar volume and may be used to objectively measure efficacy of scar treatment modalities to track scar development and resolution.     

Immunohistochemical analysis of neuropeptides (protein gene product 9.5, substance P and calcitonin gene-related peptide) in hypertrophic burn scar with pain and itching

BackgroundNeuropeptides have been recently reported as having an important role in wound repair, and relief from pain and itching sensation. The aim of this study was to evaluate the effect of neuropeptides on the wound healing process in hypertrophic scar formation that accompanies severe pain and itching sensation.MethodsWe collected forty-three hypertrophic scar specimens from hypertrophic scar release and skin graft under general anesthesia. Immunohistochemical stains for protein gene product (PGP) 9.5, substance P (SP), and calcitonin gene-related peptide (CGRP) were performed. Pain and itching over the scar were recorded using verbal numerical rating scale (VNRS).ResultsIn the epidermis, PGP 9.5, SP, and CGRP were significantly increased in hypertrophic scars compared with matched unburned skin. In the reticular dermis, SP and CGRP were significantly increased in hypertrophic scars compared with control. The pain and itching verbal numerical rating scale in scar group were significantly higher compared to control. In the papillary dermis, the PGP represented significant correlation with Itching P (correlation coefficient 0.698) and the SP represented significant correlation with pain N (correlation coefficient −0.671). In the reticular dermis, the SP represented significant correlation with pain N (correlation coefficient −0.614) and CGRP represented significant correlation with pain P/Itching P (correlation coefficient 0.801/0.611).ConclusionsNeuropeptides such as PGP 9.5, SP, and CGRP seem to affect scarring via sensory neurotransmission, it have a regulatory role for pain and itching sensation in hypertrophic scars.     

Scar massage for hypertrophic burns scarring—A systematic review

Background

Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.

Investigating the intra- and inter-rater reliability of a panel of subjective and objective burn scar measurement tools

BackgroundResearch into the treatment of hypertrophic burn scar is hampered by the variability and subjectivity of existing outcome measures. This study aims to measure the inter- and intra-rater reliability of a panel of subjective and objective burn scar measurement tools.MethodsThree independent assessors evaluated 55 scar and normal skin sites using subjective (modified Vancouver Scar Scale [mVSS] & Patient and Observer Scar Assessment Scale [POSAS]) and objective tools. The intra-class correlation coefficient was utilised to measure reliability (acceptable when >0.70). Patient satisfaction with the different tools and scar parameter importance were assessed via questionnaires.ResultsThe inter-rater reliabilities of the mVSS and POSAS were below the acceptable limit. For erythema and pigmentation, all of the Scanoskin and DSM II measures (except the b* value) had acceptable to excellent intra and inter-rater reliability. The Dermascan ultrasound (dermal thickness, intensity) had excellent intra- and inter-rater reliability (>0.90). The Cutometer R0 (firmness) had acceptable reliability but not R2 (gross elasticity). All objective measurement tools had good overall satisfaction scores. Patients rated scar related pain and itch as more important compared to appearance although this finding was not sustained when corrected for multiple comparisons.ConclusionThe objective scar measures demonstrated acceptable to excellent intra- and inter-rater reliability and performed better than the subjective scar scales.     

瘢痕内微循环的变化

目的探讨皮肤瘢痕从增生到萎缩成熟过程中组织内微循环的变化。方法采用免疫组织化学法检测烧伤创面肉芽组织、不同时期瘢痕组织和正常皮肤组织中CD34的表达，并根据CD34的表达进行血管计数，比较瘢痕浅、深层组织和不同时期瘢痕组织的血管数量、分布及形态的变化。结果各组浅、深层血管计数差异有统计学意义（P〈0．01），浅、深层血管计数，肉芽明显大于其他组（P〈0．01），1年内各组瘢痕大于1年后组瘢痕和正常皮肤组（P〈0．01）。表现为各组浅层微血管密度明显高于深层，随着皮肤瘢痕时间的增长，瘢痕组织内微血管数目逐渐减少，分布逐渐转变为有序，血管管腔通畅度逐渐增大。结论随着瘢痕时间的增长，瘢痕内微血管逐渐由新生态变为成熟态。瘢痕内正常微循环的形成可能有促进瘢痕成熟的作用。     

Measurement of vascularity in the scar: A systematic review

BackgroundVascularity is an important parameter closely associated with the scar maturation. Reliable and accurate measurement of vascularity helps to monitor the scar change and adopt targeted interventions to prevent excessive scarring and achieve promising outcomes. However, there is no consensus on the assessment tools for the vascularity measurement in scars. This systematic review presents evidence on the available vascularity measurement tools.MethodsA systematic literature search was done using PubMed, CINAHL, Embase and Science Direct databases. Studies, which used non-invasive measurement tools and explored their clinimetric properties, were identified and included in this review.ResultsA total of 1458 articles were obtained, and 26 articles were finally included in this review. Subjective vascularity measurement scales include the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS) and the modified Vancouver Scar Scale (mVSS) while objective vascularity measurement devices consist of the color-measuring device, the blood flow measuring device and the morphological imaging device.ConclusionSubjective scales are easy to use and have acceptable reliability to give a preliminary impression of the scar vascularity. Three types of objective devices are not equivalent and are mainly based on the blood flow and angiogenesis to quantify the scar vascularity.     

A comparison of two scar massage protocols in pediatric burn survivors

The current evidence to support the use of massage for scar management is conflicting in the literature. The purpose of this study was to compare two scar massage protocols administered with pediatric burn survivors to determine if a more structured and standardized approach to scar massage could improve outcome. A retrospective review of the medical records of 100 children who received massage during the time period when two different protocols were implemented was conducted and data that was collected as part of the clinical exam regarding scar height, vascularity, pliability, itch and pain were extracted. Comparisons were made within subject for scar changes from baseline to follow up and between subjects receiving Protocol A and those receiving Protocol B for the same scar characteristics. Versions of the Vancouver Scar Scale were used to assess scars, while visual analogue scale, Itch Man Scale and Wong-Baker Faces Pain Scale were used to assess itch and pain. Results demonstrated improvements in itch and vascularity over time with both scar massage protocols. However, when comparing patients who received Protocol A to those who received Protocol B, there was no difference found in scar height, vascularity, pliability, itch or pain. Using commonly applied subjective scar assessment tools, we did not find clinically meaningful changes in scar characteristics with the implementation of a structured scar massage program compared to a general approach to massage. Further research is needed to better define the impact of massage on the recovery experience for burn survivors.     

Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient’s perspective

ObjectiveThis study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn.MethodsThe Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn.ResultsThe POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn.ConclusionThe POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.     

Burn scar assessment: A systematic review of objective scar assessment tools

Purpose

All deep second and third degree burns are at risk to develop hypertrophic scars which can severely undermine the quality of survival. To assess the severity of scarring, several technical devices or tools have been introduced to evaluate one or more aspects of the scar, enabling comparison of different treatment protocols and allowing an objective follow-up. The objective of this study was to review which tools can be used in objective burn scar assessment.

Basic procedures

The Systematic literature search involving PubMed, the Web of Science (incl. Science Citation Index).

Main findings

51 articles with burn scar assessment as main topic were found. Several characteristics of the scar can be assessed, such as color, metric features and elasticity, but none of the available tools covers the whole aspect of the scar. Especially subjective factors such as pain and itching cannot be assessed with those tools, in spite of their great impact on the patient's quality of life.

Conclusions

Scar tools enable objective and reproducible evaluation of scars, which is essential for scientific studies and medico-legal purposes, and in selected cases for the clinical follow-up of an individual patient. Further studies to evaluate these tools on scars are nevertheless required.     

TGF-β和α-SMA在瘢痕组织中的表达及相关性研究

目的 检测转化生长因子－β（ＴＧＦ－β１,ＴＧＦ－β２,ＴＧＦ－β３）在增生性瘢痕和表浅性瘢痕中的表达,探讨其对增生性瘢痕的形成及α－平滑肌肌动蛋白（α－ＳＭＡ表达的可能作用。方法 采用免疫组化法检测２８例增生性瘢痕,１９例表浅性瘢痕和１６例正常皮肤组织中ＴＧＦ－β和α－ＳＭＡ的表达水平,并按年龄,性别,病程分组进行比较及ＴＧＦ－β和α－ＳＭＡ相关性分析。     

延续护理在烧伤患者瘢痕增生预防中的应用效果

探讨延续护理对烧伤患者瘢痕增生预防的价值。方法 选择2021年7月-2022年12月我院收 治的160例烧伤患者为研究对象，采用随机数字表法分为对照组与观察组，各80例。对照组予以常规出院 护理指导，观察组在对照组的基础上予以延续护理，比较两组瘢痕增生情况、对自身残疾的接受度及生活 质量。结果 观察组VSS评分低于对照组，差异有统计学意义（P＜0.05）；观察组ADS-R评分高于对照组， 差异有统计学意义（P＜0.05）；观察组BSHS-B评分高于对照组，差异有统计学意义（P ＜0.05）。结论 对 烧伤患者实施延续护理可有效预防瘢痕增生，提高患者对伤残的接受度，促进生活质量提高。     

烧伤后增生性瘢痕成纤维细胞中TRAIL受体的表达及意义

目的检测肿瘤坏死斟子相关凋亡诱导配体（TRAIL）的受体住烧伤后增生期增生性瘢痕成纤维细胞上的表达，并探讨其意义。方法应用RT-PCR和流式细胞术，检测了30例处于增生期的烧伤后增牛性瘢痕成纤维细胞中TRAIL各受体的表达，并以30例正常皮肤成纤维细胞作为对照。结果RT-PCR和流式细胞术的检测结果均显示：与正常对照组相比，增生期瘢痕的成纤维细胞中步匕亡受体DR5的表达显著降低（P〈0．05），诱导受体DcR1的表达显著升高（P〈0．05），其余受体的表达住两组间差异无统计学意义。结论烧伤后增生性瘢痕的形成可能与TRAIL介导的瘢痕内成纤维细胞凋亡受阻有关。     

The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars – A narrative review with illustrative cases

BackgroundBurn scars are a major clinical sequelae of severe burn wound healing. To effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance.MethodsA narrative review of the principles of the kinematic chain of movement and the hypothesised effect on burn scar development based on properties of burn scars was performed. An examination of the literature supporting these concepts is presented in conjunction with illustrative cases, with a particular focus on the effect of combination treatments that include ablative fractional resurfacing with surgical contracture releases.DiscussionAblative fractional resurfacing combined with the surgical release of contractures are an effective treatment modality for burn scar reconstruction. This treatment approach seems particularly effective because it is one of the only approaches where the principles of functional kinematics can be addressed when tailoring a reconstructive approach to an individual burn patient. The presented cases illustrate the importance of recognising and including the principles of functional kinematic chains in any reconstructive treatment approach for burn scars. Further, epifascial contracture bands are cord like structures which can be found underneath the subcutaneous fat of scar contractures which follow the principles of functional kinematics. Contractures can be more efficiently released if these structures are divided as well.ConclusionAblative fractional resurfacing combined with local tissue re-arrangements is a promising approach to address the underlying forces leading to hypertrophic burn scarring. To achieve an optimal outcome, it is essential to recognise and address the origin of the pathology when treating burn scars. Ablative fractional laser resurfacing allows a different scar approach as it is not limited to one surgical site and thus enables for effective treatment at the cause of the pathology.     

增生性瘢痕水泡液β转化生长因子的变化及意义

目的 研究早期瘢痕组织β转化生长因子（transforming growth factor β,TGF-β）的变化,以探索TGF-β在增生性瘢痕形成中的作用,并利用瘢痕水泡液作为研究增生性瘢痕的新途径.方法 采用酶联免疫吸附法（ELISA）检测大面积深度烧伤患者愈合后瘢痕增生早期（≤90 d）的水泡液和血液TGF-β1的含量,动态监测瘢痕早期组织TGF-β1的变化,并与正常皮肤组织水泡液和血液对照.结果 大面积深度烧伤愈合后瘢痕形成早期患者血液和正常皮肤水泡液TGF-β1的含量与正常人血液比较无升高.均低于本试剂盒最低可检测阈值（15.6 pg/L,P〉0.01）;增生性瘢痕水泡液TGF-β1含量显著高于其血液和正常皮肤水泡液（P均〈0.01）,而且瘢痕增生早期（1～3个月）组织TGF-β1逐渐升高（P〈0.01）.结论 瘢痕形成早期组织TGF-β含量增高可能是瘢痕增生的重要因素;瘢痕水泡液可作为研究增生性瘢痕的新途径.