Assessing blood flow, microvasculature, erythema and redness in hypertrophic scars: A cross sectional study showing different features that require precise definitions M.E.H. Jaspers a, b, c, d, * , C.M. Stekelenburg a, b, c, d , J.M. Simons a, b, c , K.M. Brouwer d , M. Vlig b , E. van den Kerckhove e, f , g , E. Middelkoop b, d , P.P.M. van Zuijlen a, b, c, d a Burn Center, Red Cross Hospital, Beverwijk, The Netherlands b Association of Dutch Burn Centers, Beverwijk, The Netherlands c Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands d Department of Plastic, Reconstructive and Hand Surgery and Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands e Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium f Department of Rehabilitation, Burns and Plastics, University Hospital, Leuven, Belgium g Department of Plastic Surgery, Academic Hospital, Maastricht, The Netherlands a b s t r a c t Background: In hypertrophic scar assessment, laser Doppler imaging (LDI), colorimetry and subjective assessment (POSAS) can be used to evaluate blood flow, erythema and redness, respectively. In addition, the microvasculature (i.e. presence of microvessels) can be determined by immunohistochemistry. These measurement techniques are frequently used in clinical practice and/or in research to evaluate treatment response and monitor scar development. However, until now it has not been tested to what extent the outcomes of these techniques are associated, whilst the outcome terms are frequently used interchangeably or replaced by the umbrella term ‘vascularization’. This is confusing, as every technique seems to measure a specific feature. Therefore, we evaluated the correlations of the four measurement techniques. Methods: We included 32 consecutive patients, aged 18 years, who underwent elective resection of a hypertrophic scar. Pre-operatively, we performed LDI (measuring blood flow), colorimetry (measuring erythema) and the POSAS (subjective redness) within the predefined scar area of interest (1.5cm). Subsequently, the scar was excised and the area of interest was sent for immunohistochemistry, to determine the presence of microvessels. Results: Only a statistically significant correlation was found between erythema values (colorimetry) and subjective redness assessment (POSAS) (r = 0.403, p=0.030). We found no correlations between the outcomes of LDI, immunohistochemistry and colorimetry. a r t i c l e i n f o Article history: Accepted 7 January 2017 Available online xxx Keywords: Hypertrophic scar Redness Measurement technique Scar assessment Vascularization Terminology * Corresponding author at: Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE Beverwijk, The Netherlands. Fax: +31 251265342. E-mail address: mjaspers@rkz.nl (M.E.H. Jaspers). http://dx.doi.org/10.1016/j.burns.2017.01.017 0305-4179/© 2017 Elsevier Ltd and ISBI. All rights reserved. b u r n s x x x ( 2 0 1 7 ) x x x – x x x JBUR 5166 No. of Pages 7 Please cite this article in press as: M.E.H. Jaspers, et al., Assessing blood flow, microvasculature, erythema and redness in hypertrophic scars: A cross sectional study showing different features that require precise definitions, Burns (2017), http://dx.doi.org/10.1016/j. burns.2017.01.017 Available online at www.sciencedirect.com ScienceDirect jo u rn al h o mep age: w ww .elsevier .co m /loc ate/b u rn s