Surgical outcomes of dermabrasion followed by split-thickness skin grafting for post-burn leukoderma: a two-center observational study

BACKGROUND: Post-burn leukoderma is a challenging late sequela of deep dermal injury, characterized by persistent hypopigmentation and impaired scar quality. Surgical reconstruction using dermabrasion followed by split-thickness skin grafting (STSG) is commonly employed; however, systematically collected outcome data using validated scar assessment tools for postoperative scar quality evaluation remain limited. METHODS: This two-center, observational (ambispective) study included 36 patients with stable post-burn leukoderma who underwent superficial dermabrasion followed by STSG at Afrin State Hospital and Şanlıurfa Metrolife Hospital. Perioperative clinical data from procedures performed between May 2020 and July 2024 were collected retrospectively. Following ethics approval in May 2025, prospective scar evaluations were conducted between May and July 2025 using the Patient and Observer Scar Assessment Scale (POSAS). Associations between POSAS scores and demographic or clinical variables were analyzed using non-parametric statistical methods. RESULTS: Patient- and observer-rated POSAS scores demonstrated a very strong correlation (ρ = 0.924, p < .001), indicating excellent concordance between patient-reported and clinician-assessed scar quality. Age, sex, and burn size showed no significant associations with POSAS outcomes (all p > .05). In contrast, postoperative complications were strongly associated with significantly higher (worse) POSAS scores in both patient and observer assessments (p < .001), with large effect sizes (r ≥ .68). CONCLUSIONS: Dermabrasion followed by STSG was associated with acceptable postoperative scar outcomes in patients with stable post-burn leukoderma, with strong agreement between patient and clinician evaluations of scar quality. The findings highlight complication-free healing as a key determinant of more favorable scar outcomes. Because POSAS evaluates scar quality rather than pigmentation directly, further controlled studies incorporating objective pigment-specific or colorimetric assessments are warranted to better define treatment-related repigmentation outcomes.