scar management - nonsurgical
TRANSCRIPT
Overview: Hypertrophic Scar
• Excessive scar formation after wound re-epithelialization
• Occurs in more than 50% of patients with deep second to third degree burns (dermis involved)
• Higher incidence in children/young adults and dark skinned population
• More prevalent in chest, neck, lower face burns and near joints, where tension on skin is greater.
Hypertrophic Scar Relative to Healing time-frame/Re-epithelialization
• Healing in 2 weeks = minimal to no scar• Healing in 3 weeks = minimal to no scar
except in higher risk populaiton• Healing in > 3 weeks = over 50% risk of
hypertrophic scar formation
H.S. Characteristics
• Red/Hypererythema• Raised above level of normal skin surface,
sometimes significantly• Rigid, non-pliable• Painful• Severe Itching
Scar maturation
• 4-8 weeks to full scar maturation with non-hypertrophic healing ( first degree, superficial second degree)
• Hypertrophic scars begin to appear 6 weeks – 3 months post-burn
• Peak between 3-6 months post-burn• Partially resolve between 12-18 months:
softer, flatter, paling• May take up to 2 years to completely mature
Associated problems with H.S.
• Contracture formation• Loss of ROM• Poor cosmesis• Hinders ability to return to normal activities
What can be done??
Scar Management Goal: Control scar hypertrophy and hasten scar maturation by
althering the physical and mechanical properties of scar tissue
How?
• Scar Massage• Compression garments• Silicone products• Postioning and Splinting• Exercise, stretching
Scar Massage
Benefits:• Softens scar tissue by
increasing circulation and freeing restrictive fibrous bands
• Desensitizes tissue
Technique:• In combination with
lubrication (moisturizing cream)
• During prolongued stretch• Hard enough to cause
blanching • 3-6 times / day for 5-10
minute sessions (*Patient/family education important)
Compression Therapy
• Elastic garments with ~25mmHg capillary pressure
• Should begin within 2 weeks of skin grafting or wound closure, ideally
• Should be worn 22-23 hrs/ day (removed only for personal hygiene, stretching, scar massage, and moisturizing)
• Should continue until scar matures (pale, flat, pliable)
Types of Compression
• Ace wraps• Tubigrip• Self-adherent elastic wrap (Coban)• Spandex/ Underarmor• Custom-fit garments
Topical Silicone
Known benefits:• Minimizes pain• Prevents shrinkage of grafts• Minimizes hypertrophic
scarring• Softens and smooths scar
tissue• Most effective when combined
with compression therapy
Silicone products:• Gel sheeting (thin to thick,
adhesive and non-adhesive)• Custom fabricated
elastomer molds
