A Multi-center Clinical Study Of Risk Factors Of Relevant Clinical Symptoms Of Post-burn Hypertrophy Scar

Burn is one of the most common traumatic injuries in the world.Although the success rate of treatment has been improved,ten thousands of people have been injured and maimed every year.The formation of pathological scar after burn wound is the most serious sequela of burn patients,and hypertrophic scar is one of the most important types.The main clinical manifestations of hypertrophic scar include pain,itching,skin color changes,protruding scar skin as well as severe limb dysfunction caused by contracture deformity.Therefore,these clinical manifestations often lead to pessimism,depression,sleep disorders,anxiety to participate in social activities,hard return back to normal life and other serious consequences.It will also bring huge trauma to the patient’s physical and mental health.The cost of treatment and rehabilitation often bring huge economic burden to families and society.At present,there are few studies on the clinical risk factors of the symptoms of pain,itching and paresthesia after burn scar.In this study,we made a multi-center clinical research,included 129 post-burn hypertrophy scar patients collected in three burn centers of Changhai Hospital Xiangya Hospital and the Second Affiliated Hospital of Kunming Medical University from January 2015 to January 2017.Detailed clinical data of patients’ general information,burn related treatment and some related situations of hypertrophic scar were collected.Logistic regression was used to analysis the risk factors of itching and pain which required drug intervention and paresthesia which affected patients’ daily activities.The main purpose is to provide some reference and help for clinical prevention and treatment for post-burn hypertrophy scar patients.Research objects and the overall situation 1.Research objects: Inclusion criteria:(1)accord with the diagnostic criteria of postburn hypertrophic scar;(2)at the age of 14 years and above;(3)patients who can provide detailed treatment and condition of burn and hypertrophic scar.Exclusion criteria:(1)patients under 14 year old;(2)patients who cannot provide detailed treatment and condition of burn and hypertrophic scar;(3)atrophic scar,keloid scar and other types of patients.2.Overall situation: 29 patients with post-burn hypertrophic scar were involved,including 52 cases of burn department of Changhai Hospital,57 cases of burn department of the Second Affiliated Hospital of Kunming Medical University and 20 cases of burn department of Xiangya Hospital.75 patients had scar pain symptom requiring drug intervention,accounting for 58.1%.31 patients had scar paresthesia symptom affecting their daily activities,accounting for 24%.63 patients had scar itching symptom requiring drug intervention,accounting for 48.8%.Details were given in Table 1,table 2 and table 3.Methods Based on the UNC4 P scar scale,patients were divided into "yes" and "no" two types respectively,according to whether had scar pain and pruritus symptoms which needed drug intervention,and paresthesia symptom which affects patients’ some daily activities.Based on the above classification methods,Logistic regression method was used to analyze the data.First of all,the Logistic regression analysis was used to analyze all the independent variables.The independent variables of P<0.05 were selected in the multivariate Logistic regression analysis,and stepwise regression method was used to screen the independent variables.The criteria of selection and exclusion were 0.05.Results 1.For the analysis of risk factors of scar pruritus symptom which needed drug intervention,in the test level of P < 0.05,smoking,therapeutic method of burn wound and scar softness were statistically significant.The likelihood of "appearing scar pruritus requiring drug intervention" was 3.293 times in smokers than non-smokers.The likelihood of "appearing scar pruritus requiring drug intervention" was 2.236 times in operative treatment for burn wound than non-operative treatment for burn wound.The likelihood of "appearing scar pruritus requiring drug intervention" was 0.143 times in soft scar than slightly stiff scar.2.For the analysis of risk factors of scar pain symptom which needed drug intervention,in the test level of P < 0.05,age,BMI,the thickness and hyperplasia time of scar were statistically significant.Age increased by each one year,the likelihood of "appearing scar pain symptom which required drug intervention" increased by 1.046 times.BMI increased every one unit,the likelihood of "appearing scar pain symptom which required drug intervention" increased by 1.242 times.The likelihood of "appearing scar pain symptom which required drug intervention" was 3.997 times in 2-5mm thick post-burn hypertrophic scars than < 2mm ones.And the likelihood of "appearing scar pain symptom which required drug intervention" was 4.686 times in 6-12 months hypertrophic scars than less than 6 month ones.3.For the analysis of risk factors of scar paresthesia symptom which affects patients’ some daily activities,in the test level of P < 0.05,age,burn injury factors and scar softness were statistically significant.Age increased by each one year,the likelihood of "appearing scar paresthesia symptom which affects patients’ some daily activities" increased by 1.038 times.The likelihood of "appearing scar paresthesia symptom which affects patients’ some daily activities" was 0.041 times in other burns(chemical burns,electric burn etc.)than in flame burns.And the likelihood of "appearing scar paresthesia symptom which affects patients’ some daily activities" was 4.705 times in contracture and funicular hypertrophic scars than slightly stiff ones.Conclusions: 1.The risk factors of appearing scar pruritus symptom which needed drug intervention of post-burn hypertrophic scar were smoking,operative treatment for burn wound and stiff scars.2.The risk factors of appearing scar pain requiring drug intervention of post-burn hypertrophic scar were age,BMI,2-5mm thick scar and 6-12 months scars.3.The risk factors of appearing scar paresthesia symptom which affects patients’ some daily activities were age,flame burn,contracture and funicular scars.