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Burn scar maturation can take several years but is generally studied shortly after injury. Therefore, we investigated patient-reported scar quality up to 5–7 years post-burn. Patients with ≤ 20 % total body surface area burned completed the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) on the same scar at three, > 18 months (median 28 months) and 5–7 years (median 63 months) post-burn. Fifty-eight patients (21 children; 37 adults) with a median total body surface area burned of 6.3 % participated. Average patient-reported scar quality (POSAS score) was generally worst at three months (median score: 4.2), best at 28 months (median score: 2.2) and in between at 63 months post-burn (median score: 3.4) (p < 0.001). Many patients (66 %) reported a median 1.8 point higher (worse) POSAS score at 63 months compared to 28 months post-burn, whereas 14 % reported an identical, and 21 % a lower (better) score. At any assessment, largest differences with normal skin were reported for scar colour. Univariate predictive factors of long-term patient-reported scar quality were scar quality at three months (p = 0.002) and 28 months post-burn (p < 0.001), percentage total body surface area full-thickness (p = 0.033), length of hospital stay (p = 0.003), and number of surgeries (p < 0.001). Two-third of patients with burns up to 20 % total body surface area burned scored the quality of their scars worse at 63 months compared to 28 months post-burn. Whether this corresponds to increased dissatisfaction with scars in the long-term should be further investigated. These new insights add to the body of knowledge on scar maturation and underscores the importance of discussing patients' expectations.
Dijkshoorn et al. (Wed,) studied this question.