2010年6月28日 星期一

溫哥華疤痕評量尺計分標準表進階版

游朝慶
除了上一篇兩種VSS的修改版外,現在仍然可以找到一些VSS的進階版本,如下,主要是針對疤痕高度再做細分


上面兩個圖也是一種輔助量尺工具,其總分都為15分,差異在高度的評分標準不同。

溫哥華疤痕評量尺計分標準表修改版(MVSS)

游朝慶
   有人批評前述這個溫哥華疤痕評量尺(Vancouver scar scale,VSS)分數不好記,且缺乏病人的主觀評量,如最重要的痛及癢,故有人將VSS做了一些修正如下:
Modified Vancouver Scar Scale(MVSS)1
Score Pigmentation Vascularity Pliability Height Pain and Itchiness
Normal Normal Normal Flat None
Hypopigmented Pink Supple < 2mm Occasional
Mixed Red Yielding 2-5mm Requires medication
Hyperpigmented Purple Firm > 5mm
Ropes
Contracture

    Baryza把VSS的色澤評估增加一級,讓除了柔軟度5級外,其他都為3級,並另外增加痛及癢兩項主觀評估。

Vancouver Scar Scale疤痕測量尺的Baryza修改版:


     在2000年,Nedelce B又修改了VSS,將柔軟度簡化為4級,但將疤痕高度細分成4級2,總分仍為14分,並再加上痛及癢的主觀評估。
Vancouver Scar Scale疤痕測量尺的Nedelce修改版:
*Pain and itching are also assessed and documented usually using the 0-10 scale


    關於這個modified version of the Vancouver Scar Scale,Forbes-Duchart於2007年發表一篇研究,結論是當評估燒傷疤痕的治療結果時,只有MVSS的總分能被採信,而個別項目評分的信度是很低的3,因此當某個洋蔥除疤產品根據某項研究宣稱其雖無法降低疤痕高度及柔軟度,但是可以淡疤時,我們可能需要重新思考其所代表的意義。
References
1. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil 1995; 16:535-538.
2. Nedelec B, Shankowsky HA, Tredget EE. Rating the resolving hypertrophic scar: comparison of the Vancouver Scar Scale and scar volume. J Burn Care Rehabil 2000; 21:205-212.
3. Forbes-Duchart L, Marshall S, Strock A et al. Determination of inter-rater reliability in pediatric burn scar assessment using a modified version of the Vancouver Scar Scale. J Burn Care Res 2007; 28:460-467.

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.