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Scarring case study - right upper limb and left lower limb

The aim of this case study is to illustrate that an assessment of scarring should provide a clear description of the scar/s that in turn supports an assessment with reference to all 5 of the TEMSKI criteria and all 10 of the TEMSKI descriptors. Reasoning related to the assessment of multiple scarring must also be included.

Motor Accident Details

39 year old driver of a small car which collided with a four-wheel drive.  Assessment 2 years post motor accident. Clinical appearance of mature scars. No further treatment planned.

Injuries:

  • Laceration right forearm
  • Closed comminuted fracture left patella
  • Scattered lacerations

Surgery:

  • Debridement and repair laceration right arm and left hand
  • Repair partially divided tendon left extensor carpi ulnaris tendon
  • Open reduction and internal fixation left fractured patella
  • Subsequent removal of internal fixation from his left knee.

Right arm

left hand

left knee

Description:

  1. Right arm: Fine, soft, flat, mobile scar, 10 cms long x 3 cms wide, on the posterior aspect of the proximal end of right forearm; no stitch marks; very minor contour deformity; small muscle hernia visible and slightly raised above the level of surrounding skin beneath the scar. No effect on ADLs; no treatment required.
  2. Left hand: small scar, 5 cms long, ulnar side of the dorsum of left hand; majority of scar fine, radial end of scar widened and measured 1.0cms x 0.8 cms;  scar soft and mobile; slightly hyperpigmented; no stitch marks; no contour deformity. No effect on ADLs; no treatment required.
  3. Left Knee: prominent, longitudinal scar, 15 cms long and up to 1.4 cms wide over patella of left knee;  scar soft, flat and mobile; hyperpigmented; no stitch marks; no contour deformity. Unable to tolerate prolonged kneeling which impacted ADLs in relation to cleaning and gardening; no treatment is required.

Assessment:

  • Conscious of the scarring;
  • Noticeable colour contrast of the scarring with surrounding skin;
  • Easily able to locate scars;
  • Minimal trophic changes:
  • Stitch marks barely visible:
  • Anatomical location visible:
  • Very minor contour defect as a result of the small muscle hernia:
  • Minor limitation of a few ADLs  in relation to the left knee:
  • No treatment required; &
  • No adherence.

Determination:

Overall the 3 scars best fit is in the 1% - 2% WPI range.

Reasoning:

Several factors warrant the allocation of 2% WPI. The total effect of the scars on the organ system as a whole has taken account of: the multiplicity of the scars; the visibility of all 3 scars; the minor contour defect; and, there is a minor limitation in the performance of some ADLs.

Note: The photos provide an indication of the types of scars. Some defects, such as contour defect are not clearly visible.