The evaluation of a clinical scar scale for porcine burn scars Xue-Qing Wang a, *, Olena Kravchuk b , Pei-Yun Liu a , Margit Kempf a , Carolina V.D. Boogaard a , Peter Lau a , Leila Cuttle a , Julie Mill a , Roy M. Kimble a a Department of Paediatrics and Child Health, University of Queensland, Royal Children’s Hospital, Brisbane 4029, Australia b Biometrics Unit of School of Land, Crop and Food Sciences, University of Queensland, Brisbane 4072, Australia 1. Introduction Hypertrophic scars in human burn victims presents as a raised, erythematous, pruritic and inelastic mass of tissue, which consists of a mass of hypercellular and disorganised connective tissue under a thickened epidermis [1–3]. It does not have normal skin architecture, function and appearance, and loses its capacity to grow. Minimal scar tissue and better cosmetic outcomes are the ultimate goals for all burn clinicians and for the clinical trials of potential new burn treatments. The evaluations of such scars in humans have already been described by many with satisfactory results [4–11]. This includes scar vascularity, pigmentation, pliability, height, and surface roughness, which have been assessed subjectively (in vivo and on photos) and objectively, and is well correlated with histological analyses of scars. Porcine thermal burn models have been considered the best animal model to examine wound healing on burn treatments prior to human trials [12,13]. Many of these porcine burns are large in size and deeper than superficial in depth, and resemble clinical situations where burn wounds heal with scarring [14–26]. The outcomes of these trials have burns 35 (2009) 538–546 article info Article history: Accepted 13 October 2008 Keywords: Burn injury Clinical scar assessments Histological scar assessments Re-epithelialisation Wound contraction Wound healing abstract This study describes the evaluation of a clinical scar scale for our porcine burn scars, which includes scar cosmetic outcome, colour, height and hair, supplemented with reference porcine scar photographs representing each scar outcome and scar colour scores. A total of 72 porcine burn scars at week 6 after burn were rated in vivo and/or on photographs. Good agreements were achieved for both intra-rater reliability (correlation is 0.86–0.98) and inter- rater reliability (ICC = 80–85%). The results showed statistically significant correlations for each pair in this clinical scar scale ( p < 0.01), with the best correlation found between scar cosmetic outcome and scar colour. A multivariate principle components analysis revealed that this clinical scar assessment was highly correlated with scar histology, wound size, and re-epithelialisation data ( p < 0.001). More severe scars are clinically characterised by darker purple colouration, more elevation, no presence of hair, histologically by thicker scar tissue, thinner remaining normal dermis, are more likely to have worse contraction, and slower re- epithelialisation. This study demonstrates that our clinical scar scale is a reliable, inde- pendent and valuable tool for assessing porcine burn outcome and truthfully reflects scar appearance and function. To our knowledge, this is the first study demonstrating a high correlation between clinical scar assessment and scar histology, wound contraction and re- epithelialisation data on porcine burn scars. We believe that the successful use of porcine scar scales is invaluable for assessing potential human burn treatments. # 2008 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author at: Department of Paediatrics and Child Health, University of Queensland, Royal Children’s Hospital, Level 3, Foundation Building, Herston Road, Herston, Brisbane 4029, Australia. Tel.: +61 7 3365 5019; fax: +61 7 3365 5455. E-mail address: x.wang@uq.edu.au (X.-Q. Wang). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.10.005