Scar Cosmesis: Assessment, Perception, and Impact on Body Image and Quality of Life—A Systematic Review

Abstract

Objectives: (1) Review current validated scar assessment tools and (2) describe the impact of scar cosmesis perception on body image and quality of life. Methods: Three independent reviewers performed comprehensive searches and identified 680 English language studies published between 1950 and 2014 (data sources: Medline, EMBASE, Cochrane Library, and Web of Science). Literature including case series, cross sectional studies, meta-analyses, and reviews was then screened and selected according to strict inclusion/exclusion criteria. Results: Scar assessment: Review included Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, Manchester Scar Scale, Wound Evaluation Scale, and Western Scar Index. Validated qualitative assessment tools were clinically more useful than their quantitative counterparts. Patient perception input increased validity. Subjective satisfaction rating had little correlation with objective assessment of scarring. Perceptions: The size of defect did not correlate with impact, however location and visibility did. Psychosocial distress correlated with subjective severity. The large impact on physical and psychosocial quality of life (ascertained by generic and symptom-specific validated assessment tools, as well as qualitative studies with interpretive phenomenologic analysis) is not to be overlooked. Conclusions: Careful selection of scar assessment tools is vital to gauge severity and plan further treatment. No consensus exists on the single most appropriate tool. A validated assessment tool is important in the assessment of scarring. There is a tendency to underestimate and thereby worsen the impact of scarring on patients’ quality of life. Further studies are required, particularly in the context of thyroid surgery.