2010年6月27日 星期日

溫哥華疤痕評量尺(Vancouver scar scale,VSS)

游朝慶

    溫哥華疤痕評量尺(Vancouver scar scale,VSS)是由加拿大溫哥華總醫院燒傷中心的Sullivan於1990年發表出來1,或許是世界上最廣為熟知的燒傷疤痕評估系統,又被公認為Burn Scar Index。其採用色澤(Pigmentation)、厚度(height)、血管分佈(vascularity)、柔軟度(pliability)四個指標對疤痕進行描述性評價,評分標準如下:

Pliability柔軟度

0

Normal

1

Supple柔軟的(在最少阻力下皮膚能變形的)Supple, flexible with minimal resistance)

2

Yielding有彈性的,柔順的(在壓力下能變形的)(giving way to pressure, offering moderate resistance but does not behave as a solid mass of scar)

3

Firm結實的,硬的(不能變形的,移動呈塊狀,對壓力有阻力(solid, inflexible unit, not easily moved, resistant to manual pressure)

4

Banding彎曲(組織如繩狀,瘢痕伸展時會退縮)(rope-like tissue that blanches with extension of scar, does not limit ROM)

5

Contracture攣縮(瘢痕永久性短縮導致殘廢與扭曲)(permanent shortening of the scar producing deformity or distortion, limits ROM)

Height厚度

0

Normal

1

<2 mm

2

2-5 mm

3

>5 mm

Vascularity血管分布

0

Normal瘢痕膚色和身體正常部位近似

(redness)

1

Pink膚色偏粉紅(slight increase in local blood supply)

2

Red膚色偏紅(significant increase in local blood supply)

3

Purple膚色呈紫色(excessive increase in local blood supply)

Pigmentation色澤

0

Normal color (close to normal skin)

1

Hypopigmentation色澤較淺

2

Hyperpigmentation色澤較深

Total score

13

    除了燒傷疤痕外,也有人證實VSS對手術傷口的線性疤痕的評估也有效2,3

References

1. Sullivan T, Smith J, Kermode J et al. Rating the burn scar. J Burn Care Rehabil 1990; 11:256-260.

2. Truong PT, Abnousi F, Yong CM et al. Standardized assessment of breast cancer surgical scars integrating the Vancouver Scar Scale, Short-Form McGill Pain Questionnaire, and patients' perspectives. Plast Reconstr Surg 2005; 116:1291-1299.

3. Truong PT, Lee JC, Soer B et al. Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery. Plast Reconstr Surg 2007; 119:487-494.

3 則留言:

  1. 醫師您好^^
    我有兩個問題想問~

    1. 為什麼會發生皮膚攣縮?
    2. 厚的瘢痕和蟹足腫有不一樣嗎? 一樣是第三型膠原蛋白

    謝謝~

    回覆刪除
    回覆
    1. 1.在開放性傷口,癒合的第一步,除了止血,就是傷口收縮,在疤痕組織,隨著時間,疤痕也會收縮,但若影響到關節活動功能,就稱攣縮姓疤痕
      2.厚的瘢痕只在原本傷口上變厚,蟹足腫則會比原本的傷口大好幾倍

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