Burn Scar Management Michael Serghiou, OTR Shriners Hospitals for Children mserghiou@

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Transcript of Burn Scar Management Michael Serghiou, OTR Shriners Hospitals for Children mserghiou@

  • Slide 1
  • Burn Scar Management Michael Serghiou, OTR Shriners Hospitals for Children mserghiou@shrinenet.org
  • Slide 2
  • Scar Management Scar: The fibrous tissue replacing normal tissue destroyed by injury or disease. Hypertrophic Scar: Overgrowth of dermal contents that remains with the boundaries of the wound. Keloid: A scar that extends beyond the boundaries of the original wound.
  • Slide 3
  • Hypertrophic Scar HTS begins to appear 6 weeks to 3 months post burn. Maximum height of scar is seen 3 to 9 moths post burn. Average time for scar maturation is approx. 1 year; it can range from 6 months to 2 years.
  • Slide 4
  • Red Raised Rigid Pale Planar Pliable Immature vs. Mature
  • Slide 5
  • Factors Contributing to HTS Formation Prolonged healing time Repeated harvesting of donor sites Race Age Location Depth Tension Gender
  • Slide 6
  • A rating scale for assessing scar maturation. The scale rates 4 burn scar characteristics: -Pigmentation -Vascularity -Pliability -Height Vancouver Scar Assessment
  • Slide 7
  • Pressure Therapy
  • Slide 8
  • Effects of pressure through vascular support garments first reported by Dr. Silverstein in 1971 Effect of pressure through splinting first reported by Dr. Larson Although mechanism of pressure effects on scars has not been identified, effects of pressure on hypertrophic scars are well documented
  • Slide 9
  • Pressure therapy i.e. garments Inserts Massage Modalities Treatment of Hypertrophic Scar
  • Slide 10
  • Accelerates scar maturation Flattens the scar Increases pliability Decreases blood flow Realigns collagen bundles Decreases edema Decreases the rate of collagen synthesis/lysis Effects of Compression Therapy
  • Slide 11
  • Should begin within 2 weeks of wound closure Must be constant; 22-23 hours a day Pressure is required until the scar is mature Timing of Pressure Application
  • Slide 12
  • Pre-fabricated or custom made Need to be worn 22 hrs. a day Average garment pressure, 25-30 mmHg 10mm Hg minimum for hand scar remodeling >40mm Hg destructive Pressure Garments
  • Slide 13
  • Indications for Pressure If the wound heals in