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Visual Assessment of Linear Scars: A New Tool

Kerrigan, Carolyn L. M.D.; Homa, Karen Ph.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1513-1519
doi: 10.1097/PRS.0b013e3181b9898e
Reconstructive: Trunk: Original Articles

Background: Existing scar evaluation tools are based on verbal descriptions and used primarily for burn scar assessment. To evaluate linear scars, the authors developed a new tool called the visual assessment of linear scars. This study was designed to determine whether patients and surgeons rated scars similarly and to test the intrarater and interrater reliability of the surgeons’ ratings.

Methods: At 6 months postoperatively, 51 patients used the visual assessment of linear scars tool to rate each of their own surgical scars (two scars for abdominal; six scars for breast), and two surgeons used the visual assessment of linear scars tool to rate the patients’ scar photographs. A post hoc two-sample t test was used to determine whether the raters’ scar means were significantly different from each other. Spearman correlation was used to determine the intrarater and interrater reliability.

Results: There was no difference in the mean scar ratings between the surgeons; however, both surgeons had significantly higher mean ratings than the patients (a higher score is a worse-appearing scar). Intrarater reliability for the surgeons was large (ρ > 0.5) and interrater reliability between the surgeons was also large (ρ = 0.53) but borderline.

Conclusions: The visual assessment of linear scars tool was developed to create a simple, straightforward method of assessing the overall appearance of the postsurgical linear scar, keeping in mind that the patient’s perspective might differ from that of a surgeon or researcher. Both patients and surgeons found the ratings easy to perform, and the results showed that patients might rate their scars’ appearance more favorably than the surgeons. The visual assessment of linear scars is a reliable tool with two plastic surgeons’ rating of repeated photographs.

Lebanon, N.H.

From the Section of Plastic Surgery and the Dartmouth-Hitchcock Leadership Preventive Medicine Residency Program, Dartmouth Hitchcock Medical Center.

Received for publication October 18, 2008; accepted May 20, 2009.

Presented at the 49th Annual Meeting of the New England Society of Plastic and Reconstructive Surgeons, in Manchester, Vermont, June 6 through 8, 2008.

Disclosure: This study was funded by an unrestricted research grant to the Hitchcock Foundation from 3M as part of an ongoing study of Steri-Strip S Surgical Skin Closure. Dr. Kerrigan is the principal investigator on this grant.

Carolyn L. Kerrigan, M.D., Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, N.H. 03756,

©2009American Society of Plastic Surgeons