Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population

• Published in: Burns Vol. 45; no. 5; pp. 1066 - 1074
• Main Authors: Rotatori, R. Maxwell, Starr, Brian, Peake, Mitchell, Fowler, Laura, James, Laura, Nelson, Judy, Dale, Elizabeth L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2019
• Subjects: African Americans; autograft; Body Surface Area; Burns - pathology; Burns - surgery; Child; Child, Preschool; Cicatrix, Hypertrophic - epidemiology; Cicatrix, Hypertrophic - ethnology; Cicatrix, Hypertrophic - pathology; donor site; European Continental Ancestry Group; Female; Hispanic Americans; Humans; Hypertrophic scarring; Male; pediatric; Prevalence; Re-Epithelialization; Retrospective Studies; Risk Factors; Skin - pathology; skin graft; Skin Transplantation; Time Factors; Tissue and Organ Harvesting - methods; Transplant Donor Site - pathology; Transplantation, Autologous; autograft; Hypertrophic scarring; donor site; skin graft; pediatric
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2019.02.003

•1/3 of patients to never experience hypertrophic scarring of their donor sites.•1/3 of patients have donor site hypertrophic scarring that resolved.•1/3 of patients have hypertrophic scarring that persisted.•Re-epithelialization time, %TBSA, harvest depth increase hypertrophic scarring risk. Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population. The split-thickness autograft remains a fundamental treatment for burn injuries; however, donor sites may remain hypersensitive, hyperemic, less pliable, and develop hypertrophic scarring. This study sought to assess the long-term scarring of donor sites after pediatric burns. A retrospective review of pediatric burn patients treated at a single institution (2010–2016) was performed. Primary outcomes were prevalence of donor site hypertrophic scarring, scarring time course, and risk factor assessment. 237 pediatric burn patients were identified. Mean age at burn was 7 yrs., mean %TBSA was 26% with 17% being Full Thickness. Mean follow-up was 2.4 yrs. Hypertrophic scarring was observed in 152 (64%) patients with 81 (34%) patients having persistent hypertrophic scarring through long-term follow-up. Patient-specific risk factors for hypertrophic scarring were Hispanic ethnicity (P=0.03), increased %TBSA (P=0.03), %Full Thickness burn (P=0.02) and total autograft amount (P=0.03). Donor site factors for hypertrophic scarring were longer time to epithelialization (P<0.0001), increased donor site harvest depth (P<0.0001), autografts harvested in the acute burn setting (P=0.008), and thigh donor site location (vs. all other sites; P<0.0001). The scalp, arm, foot, and lower leg donor sites (vs. all other sites) were less likely to develop HTS (P<0.0001, 0.02, 0.005, 0.002, respectively), along with a history of previous donor site harvest (P=0.04). Hypertrophic scarring is a prominent burden in donor site wounds of pediatric burn patients. Knowledge of pertinent risk factors can assist with guiding management and expectations.