An examination of scar modelling and assessment methods for the evaluation of treatments

Scarring is the final common pathway for healing within the skin irrespective of age, gender and race. Scars can be itchy, painful, tight and above all, cosmetically disfiguring. Despite advances in surgery and trauma management, there is currently no reliably effective treatment for reducing or preventing scarring. The primary aim of this thesis is to assess the currently available models for scarring and evaluate/further develop the utility of current assessment tools, in an effort to design a pilot randomised control trial for silicone gel treatment of scars. Review of scar models in humans and animals demonstrated the limitations and drawbacks of many existing methods to assess scar treatments. Examination of currently used subjective and objective scar assessment tools in a plastic surgery clinic helped to develop protocols and methodology for a scar treatment research trial. Long-term scar outcomes assessed using a novel subjective patient reported outcome measure for paediatric burn patients demonstrated no statistically significant difference between those treated surgically, and those treated conservatively. A pilot randomised control trial to produce high quality evidence for silicone gel sheeting in the treatment of scars was set up and successful in recruitment. Scarring remains a difficult condition for clinicians to manage, with many treatments utilised on a poor evidence basis. Here, we have demonstrated difficulties in establishing a scientific scar treatment model; and created a pilot study that will help to provide high quality evidence for the efficacy of silicone gel sheeting as a treatment for scars.