Bismillahirahmanirahim
Definition
A Scar is the inevitable result of damage
to the dermis of the skin ,characterised by excessive amounts of collagen
deposition
Normal
Healing Process
a.
Bleeding Phase 6 hours – 24
hours
b.
Inflammatory Phase few hours –two weeks
c.
Proliferation Phase 2 days – several months
d.
Remodelling Phase 2 week – 2
years !
Optimal Scarring
Follows
·
Non infected wound
·
Tension free wound
·
Well aligned edges
·
Patient with no underlying
medical history
Excessive
scarring can result from…
·
Infection
·
Foreign bodies #
·
Haematoma
·
Poorly aligned wound edges #
·
Crush injury #
·
Genetic factors #
·
Pregnancy #
·
Mechanical tension
( # factors out with
therapist control )
Hypertrophic scars (Definition)
Exuberant scar that remains within the limits of the original wound
Clinical
Characteristics
1.
Red, itchy, and raised
2.
Develops 6-8 weeks after
epithelialisation
3.
Regresses spontaneously
4.
All areas are susceptible
Keloid Scars
(Definition)
Exuberant scar that exceeds the boundaries of the original wound
(William 1996)
Derived from the Greek word ‘Chele’ meaning crab claw
Clinical
Characteristics
·
Common in 10-30 year olds
·
Florrid and grossly raised
·
Hypersensitive
·
Does not usually regress
spontaneously
·
Familiar/genetic
·
Africans more susceptible
·
Regressive and difficult to
treat
Hypertrophic and Keloid
scars are most common
·
Areas of high tension/movement
·
Earlobe
·
Anterior surface of the neck
·
Shoulder
·
Chest wall
·
Flexor surface of the
extremities
Methods of scar
management
·
Surgery
·
Radiation
·
Pharmacological
Electrotherapy
By enhancing the endogenous electrical
activity of damaged tissues the growth/healing processes can be stimulated
(Brighton et al 1981)
Injured tissues are electrically active as
shown in skin repair ( Barker et al )
Modalities
: Ultrasound
Acoustic streaming main affect increases
protein synthesis
Useful in proliferation and remodelling
phases
Pro inflammatory
Increases wound strength ( Dyson 1981)
Affects A beta fibres ( help
hypersensitivity?)
Modalities
: Laser
Works by photobioactivation and
monochromaticity
Triggers the regression of bld vessels and
decreases fibroblasts
Dose 0.4 – 4 j/cm2
Effective in bleeding and inflammatory
phases
Therapeutic
methods of scar management
·
Pressure garments
·
Massage
·
Splints
·
Active and passive exercises
·
Hypersensitivity program
·
Silicone products
Summary
1.
Detailed Medical History esp.
aspirin steroids etc
2.
Predisposing factors for
abnormal healing i.e. genetic, pregnancy etc
3.
Limit reduction of dressings in
first two weeks
4.
Encourage anti inflammatory in
high risk pts
5.
Limit mechanical tension from
splintage
6.
Use accessory mobilisations to
increase joint ROM rather than passive stretching
7.
Use laser in bleeding /
inflammatory phases
8.
Use ultrasound in proliferation/remodelling phase
9.
Start hypersensitivity
programme as soon as possible with high risk patients
10. Avoid heavy tapping in high risk pts
11. Avoid firm massage in high risk patients
12. Use silicone gel as
prevention in high risk patients
Wallahuaklam..
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