2.2. Vancouver scar scale

The Vancouver scar scale (VSS) rated four physical characteristics of scars: vascularity, pigmentation, pliability, and height.^[9,10] The total score (ranging from 0–13) was obtained by summing the scores of the four parameters. The lower the score, the more the scar represented normal skin. Other studies have provided evidence that the VSS is a reliable and effective device to assess linear surgical scars.^[11,12] Internal consistency was acceptable for the VSS, with Cronbach alpha values ranging from 0.71∼0.79.^[11,12] For these reasons, the study used the VSS as the standardized scar assessment tool. Two occupational nurse practitioners with more than 6 years of experience each in liver transplant units assessed the physical characteristics of the scars. They accepted training from a plastic surgeon. The training included a 30-minute session in which observers were taught in detail the four physical characteristics of scars used in the VSS. The study proceeded with the assessment of three donors’ scars; the interobserver reliability was excellent for the VSS score (0.805). A scar was classified as a poor scar if its total VSS score was higher than 4.