Vitamin D Deficiency as a Risk Factor for Hypertrophic Scarring and Reconstructive Surgeries After Burns

Abstract Background Vitamin D plays an important role in immune regulation, collagen remodeling, and wound healing. In the general population, deficiency has been associated with poor wound repair and fibrosis, yet evidence in burn patients remains limited. Burn injuries often result in hypertrophic scarring and significant healthcare utilization for reconstructive and adjunctive procedures. Objectives This study examines the impact of preexisting vitamin D deficiency on hypertrophic scarring and scar-related healthcare utilization in a large, multi-institutional cohort of burn patients. Methods The TriNetX Research Network was queried for patients ≥18 years old with burn injuries between 2010 and 2023. Patients with vitamin D deficiency, defined as 25-hydroxyvitamin D < 20 ng/mL within one month prior to injury, were matched 1:1 to non-deficient controls using propensity score matching. Matching variables included demographics, body mass index, comorbidities, substance use, vitamin deficiencies (A, C, E, and K), calcidiol levels, and total burn surface area. The primary outcome was hypertrophic scarring. Secondary outcomes included scar-related interventions: Z-plasty and intralesional corticosteroid injections. Cumulative incidence was assessed at 3, 12, and 24 months. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Results After matching, 6,832 patients were included in each cohort. Vitamin D deficiency was associated with significantly higher rates of hypertrophic scarring at 3 months (5.82% vs 2.55%, HR 2.33, 95% CI 1.93–2.81, p < 0.0001), 12 months (9.38% vs 4.56%, HR 2.12, 95% CI 1.84–2.46, p < 0.0001), and 24 months (10.61% vs 5.26%, HR 2.09, 95% CI 1.83–2.40, p < 0.0001). Vitamin D deficient patients also demonstrated greater use of reconstructive procedures, including Z-plasty (HR 1.86–2.38) and corticosteroid injection (HR 3.14–3.56). Conclusions Vitamin D deficiency is strongly associated with increased hypertrophic scarring and greater reliance on reconstructive and adjunctive procedures following burn injury. These results underscore the potential role of micronutrient status in long-term burn recovery. Prospective studies are needed to determine whether early detection and correction of deficiency can mitigate scarring and reduce healthcare utilization.