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scar management - nonsurgical
This document discusses strategies for managing hypertrophic scarring after burns. Hypertrophic scarring occurs in over 50% of deep second and third degree burns and is more common in certain high-risk populations. Scars begin appearing between 6 weeks to 3 months post-burn and peak between 3-6 months as the scar matures over 12-18 months. Scar management aims to control scar hypertrophy and hasten maturation. Recommended approaches include scar massage, compression garments, topical silicone products, positioning, splinting and exercise to soften scars and prevent loss of range of motion.
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scar management - nonsurgical
- 1. Scar Management non surgicalapproach Dr sumer yadav Mch plastic surgery sumeryadav2004@gmail.com
- 2. 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. sumeryadav2004@gmail.com
- 3. Hypertrophic Scar Relativeto 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 sumeryadav2004@gmail.com
- 4. H.S. Characteristics • Red/Hypererythema •Raised above level of normal skin surface, sometimes significantly • Rigid, non-pliable • Painful • Severe Itching sumeryadav2004@gmail.com
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- 6. Scar maturation • 4-8weeks 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 sumeryadav2004@gmail.com
- 7. Associated problems withH.S. • Contracture formation • Loss of ROM • Poor cosmesis • Hinders ability to return to normal activities sumeryadav2004@gmail.com
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- 9. What can bedone?? Scar Management Goal: Control scar hypertrophy and hasten scar maturation by althering the physical and mechanical properties of scar tissue sumeryadav2004@gmail.com
- 10. How? • Scar Massage •Compression garments • Silicone products • Postioning and Splinting • Exercise, stretching sumeryadav2004@gmail.com
- 11. Scar Massage Benefits: • Softensscar 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) sumeryadav2004@gmail.com
- 12. Compression Therapy • Elasticgarments 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) sumeryadav2004@gmail.com
- 13. Types of Compression •Ace wraps • Tubigrip • Self-adherent elastic wrap (Coban) • Spandex/ Underarmor • Custom-fit garments sumeryadav2004@gmail.com
- 14. Self-adherent elastic wrapAce wrap sumeryadav2004@gmail.com
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- 16. Spandex/Under armor Customcompression garments sumeryadav2004@gmail.com
- 17. 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 sumeryadav2004@gmail.com
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