Scar Management
Scar:
- A skin graft or healed burn wound is vascular, flat, and soft.
- The newly healed areas may become raised and firm.
- Pressure has been used successfully to accelerate scar maturation and minimize hypertrophic scar formation. But no one study validates the mechanism by which pressure alters scar tissue.
1. Pressure Dressings:
Elastic wraps can be used to provide vascular support of skin grafts and donor sites, as well as to control edema and scarring.
Elastic wraps should be used until a patient's skin or scars can tolerate the shearing force of a pressure garment.
Elastic wraps are applied in a figure-of-eight pattern on the Lower extremities(UEs).
A spiral wrap can be used on the upper extremities(UEs) and a circular wrap on the trunk.
a. Self-adherent elastic bandage:
They can be used for the hand and toes.
It helps to minimize edema and control scar formation.
It may be used before the application of a customized pressure glove or definitive pressure on an infant's hand.
They provide a moderate amount of compression.
It may be used as temporary garments before a custom-made garment is fitted.
It is useful for small children who grow rapidly and require frequent alterations in garment size.
c. Pressure garments:
Some garments are ready-made and come in several sizes to fit most patients & others are custom-made for the individual patient (Fig. 1).
The garments are very tight, and difficult to apply, but the pressure is necessary to prevent scar hypertrophy.
Fig. 1: Pressure garments Garments can be ordered for any or all body parts, including the face and head, and they come in many styles, options, and colors.
Garments usually are worn 23 hours a day (removed for bathing) for as long as 12 to 18 months to assist with scar remodeling.
Garments should be washed daily to prevent the buildup of perspiration and moisturizing cream, which may lead to scar maceration.
2. Silicone Gel:
Silicone gel has demonstrated effectiveness in managing hypertrophic scar.
Sheets of silicone polymer gel (Fig. 2) may be applied directly over an actively maturing scar.
There are varying sizes of these silicone gel sheets. The mechanism of action for the treatment outcome is unknown.
The only complication with silicone gel sheet use is local rash and skin break down.
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| Fig. 2: Sheet of silicone gel |
3. Massage:
Massage is an intervention that clinically appears useful to assist with ROM exercise by making the tissue more pliable.
Deep friction massage is thought to loosen scar tissue by mobilizing cutaneous tissue from underlying tissue and acting to break up adhesions.
Fig. 3: Massage of scar due to burn When massage is used in conjunction with ROM exercise, the immature scar can be elongated more easily, and a developing contracture can be corrected.
Firm scars that are routinely massaged tend to soften. Edges or seams of grafts or any area that is raised and firm may benefit from massage.
4. Camouflage Make-up:
For scars of the face, neck, and hands, camouflage makeup can be used.
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| Fig. 4: Camouflage makeup for skin discoloration |
- Make-up can be used before scar maturation when the scar is still red, and a patient wants to go out in public without his or her pressure garments or devices for short periods of time.
These cosmetics are opaque, color correct burn scars, and are available in multiple shades to accommodate various skin colors. They also are waterproof and can be worn during all activities.
These products can be purchased in larger department stores.
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