scar management - nonsurgical
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scar management - nonsurgical
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scar management - nonsurgical
- 1. Scar Management non surgical approach 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 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 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
- 6. 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 sumeryadav2004@gmail.com
- 7. Associated problems with H.S. • Contracture formation • Loss of ROM • Poor cosmesis • Hinders ability to return to normal activities sumeryadav2004@gmail.com
- 9. What can be done?? 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: • 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) sumeryadav2004@gmail.com
- 12. 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) 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 wrap Ace wrap sumeryadav2004@gmail.com
- 16. Spandex/Under armor Custom compression 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