Skip Navigation LinksHome > March 2012 - Volume 25 - Issue 3 > Digital Imaging Analysis of Scar Aesthetics
Advances in Skin & Wound Care:
doi: 10.1097/01.ASW.0000412907.43335.a2
Features: Original Investigation

Digital Imaging Analysis of Scar Aesthetics

Valente, Jonathan H. MD; Jay, Gregory D. MD, PhD; Schmidt, Scott T. MD; Oh, Albert K. MD; Reinert, Steven E. MS; Zabbo, Christopher P. DO

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Abstract

OBJECTIVE: Aesthetic outcome is an important end point of wound care. The purpose of this study was to compare a wound aesthetic scoring system by emergency physicians, patients, and digital imaging by blinded plastic surgeons. The goal was to see if digital photography could accurately analyze the aesthetics of closed lacerations for future research.

METHODS: This was a subanalysis of a prospective, randomized trial conducted in an urban, academic emergency department. Patients aged 18 to 100 years were included if they had simple, uncomplicated lacerations 8 hours old or less located on the trunk, head or neck (not scalp), or extremities that required repair by sutures. Exclusion criteria included immunocompromised state of health, a complicated laceration, specialty consultant intervention in management of the wound, or current use of or need for antibiotics for wound prophylaxis. Complicated lacerations were defined in the article. Infection outcomes, demographics, and aesthetic outcomes were assessed. Scar appearance was assessed at 3 to 4 months after closure using a previously validated 0-to 100-mm visual analog scale (VAS) score and 6-point wound evaluation score (WES) done by 2 trained emergency physicians (MD1 and MD2). Patients also performed self-VAS (VASPt), whereas VAS was done using digital imaging by 2 trained plastic surgeons (VASPlast1 and VASPlast2). Data were evaluated when both plastic surgeons independently believed that the digital images were able to be adequately scored. Pearson correlation coefficients were performed using mean values.

RESULTS: Three-to 4-month VASMD and WESMD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VASPt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VASPlast in 34 of 66 (51.5%). Mean scores for VASMD1 and VASMD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WESMD1 and WESMD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VASPt were 86.6 (SD, 16.6) mm. Mean scores for VASPlast1 and VASPlast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VASMD1 and VASMD2 (r = 0.63; n = 34; P < .001), WESMD1 and WESMD2 (r = 0.70; n = 34; P < .001), and VASPlast1 and VASPlast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VASMD and VASPlast (r = 0.56; n = 34; P < .001), VASPt and WESMD (r =0.60; n = 34; P < .001), and VASMD and WESMD (r = 0.64; n = 34; P < .001). However, correlations were weak for VASPt and VASPlast at r = 0.25 (n = 34; P = .16), VASPt and VASMD at r = 0.37 (n = 34; P =.03), and WESMD and VASPlast at r = 0.13 (n = 34; P =.45).

Three-to 4-month VASMD and WESMD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VASPt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VASPlast in 34 of 66 (51.5%). Mean scores for VASMD1 and VASMD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WESMD1 and WESMD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VASPt were 86.6 (SD, 16.6) mm. Mean scores for VASPlast1 and VASPlast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VASMD1 and VASMD2 (r = 0.63; n = 34; P < .001), WESMD1 and WESMD2 (r = 0.70; n = 34; P < .001), and VASPlast1 and VASPlast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VASMD and VASPlast (r = 0.56; n = 34; P < .001), VASPt and WESMD (r =0.60; n = 34; P < .001), and VASMD and WESMD (r = 0.64; n = 34; P < .001). However, correlations were weak for VASPt and VASPlast at r = 0.25 (n = 34; P = .16), VASPt and VASMD at r = 0.37 (n = 34; P =.03), and WESMD and VASPlast at r = 0.13 (n = 34; P =.45).

Three-to 4-month VASMD and WESMD follow-up was obtained in 66 of 175 (37.7%), 3-to 4-month VASPt follow-up was obtained in 70 of 175 (40.0%), and 3-to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VASPlast in 34 of 66 (51.5%). Mean scores for VASMD1 and VASMD2 were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WESMD1 and WESMD2 were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VASPt were 86.6 (SD, 16.6) mm. Mean scores for VASPlast1 and VASPlast2 were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VASMD1 and VASMD2 (r = 0.63; n = 34; P < .001), WESMD1 and WESMD2 (r = 0.70; n = 34; P < .001), and VASPlast1 and VASPlast2 (r = 0.74; n = 34; P < .001). Correlations were also moderate for VASMD and VASPlast (r = 0.56; n = 34; P < .001), VASPt and WESMD (r =0.60; n = 34; P < .001), and VASMD and WESMD (r = 0.64; n = 34; P < .001). However, correlations were weak for VASPt and VASPlast at r = 0.25 (n = 34; P = .16), VASPt and VASMD at r = 0.37 (n = 34; P =.03), and WESMD and VASPlast at r = 0.13 (n = 34; P =.45).

CONCLUSIONS: Correlations were moderate for VASMD and VASPlast; however, correlations were weak for VASPt and VASPlast, VASPt and VASMD, and WESMD and VASPlast. This small study assessing digital imaging as a tool for evaluating scar aesthetics demonstrated limitations in its use. Future studies with larger populations and improved imaging modalities, such as 3-dimensional cameras and high-dynamic-range imaging, may provide potential for better assessment.

© 2012 Lippincott Williams & Wilkins, Inc.

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