Scar Management: Difference between revisions
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'''Pliability:''' | |||
'''Pliability:''' This refers to the extensibility or elasticity of skin | |||
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| '''Methods''' | | '''Methods''' | ||
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|Histologic analysis | |Histologic analysis | ||
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'''Transepidermal Water Loss and Transepidermal Oxygen''' | '''Transepidermal Water Loss and Transepidermal Oxygen''' | ||
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== Standardized outcomes == | |||
Burns scar index (vancouver Scar scale): Measures Pliability, pigmentation, vascularity and height | Burns scar index (vancouver Scar scale): Measures Pliability, pigmentation, vascularity and height | ||
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Numerical scar rating scale: Border height of the scar, scar stiffness, color difference and the thickness of the scar. | Numerical scar rating scale: Border height of the scar, scar stiffness, color difference and the thickness of the scar. | ||
== | == Scar Management == | ||
'''Aim:''' Altering the physical an mechanical properties of the scar by influencing the scar maturation process. Also promoting tissue strength and gliding by preventing adhesions. | |||
<references /> | <references /> |
Revision as of 18:24, 7 December 2020
Introduction[edit | edit source]
Scars are the normal and unavoidable outcomes of tissue healing where the fibrous tissue replaces normal tissue as a part of the remodeling phase of wound healing. The collagen synthesized initially is random and constituting bulky fibers, which eventually remodels along the lines of tension. As this normal process occurs there is a risk of adhesions in the adjacent tissues. Eventually, these collagen fibers are replaced with stronger and more organized collagen, representing a smoother and flat scar which is paler in appearance.[1]
A scar that stays within the boundaries of the original wound is a firm scar.
Keloid[edit | edit source]
Scars that progressively encroach on the surrounding area of skin tissue resulting in a cosmetic and emotional distress. They frequently develop in areas rich in blood supply like the ear lobe or the presternal area.
Hypertrophic scars[edit | edit source]
Prolonged inflammation causes excessive collagen deposition with an increased adhesiveness and contractility of the scar. The resulting scare is red, vascular, immobile and raised. This can adversely affect range of motion and cause functional limitations when present around a joint.[1]
Assessment[edit | edit source]
Objective measures:
Size: A scar usually undergoes a period of over growth before maturing and becoming flatter.
Method | Use |
---|---|
Mark points along the scar and measure length, width, height and elevation with a ruler | Easy method for rough quantification, |
Photographing the scar or tracing it onto a piece of paper | Easy, inexpensive in clinical use, however unable provide quantification |
Negative impression made of the scar in a dental stone, used to later reproduce a positive impression of the scar. | Objective and quantifiable, difficult to use in clinical setting |
Ultrasonography of the scar | Quantifies size of the scar both above and below the surface of the skin(depth of the scar), however this is time consuming |
Color: This is a measure of vascularity as well as pigmentation (measure of the melanocytes, bile ad carotene pigments).
Method | Use |
---|---|
Visual observation, photographic analysis | Non standardized, rough method |
Color control strips, computer packages like adobe allocate numerical values to colors | Not validated, but convinient |
Pliability: This refers to the extensibility or elasticity of skin
Methods | Use |
Range of motion assessment | It however is an indirect assessment of function and not merely a measure of the scar |
Vertical pressure tools
Cicatronometer: hand held tonometer that's held vertically on the skin, depressed is an indicator rod. The firmer the skin the higher the rod will move Mdodified Shiotz tonometer: this device even gives a reading of the power required for a given deformation. |
Properties good against the ultrasound, however not used frequently |
Horizontal Stretch tools: These are the extensometer and elastometer | The reliability of these tools is yet to be tested. |
NK Derma Durometer: This is a computerised device that uses the pressure required to deform skin through the electric resistance of skin. | Non invasive, esy to use, objective but expensive |
Cutometer: Measures vertical deformation using a suction device | Highly sensitive, |
Temperature
The temperature of a scar is dependent o the vascularity and amount of metabolic activity.
Methods | Use |
---|---|
Infrared camera or Infrared tympanic thermometer | Non invasive method of assessing temperature |
Biopsies to detect changes | Histologic analysis |
Transepidermal Water Loss and Transepidermal Oxygen
The water loss across the skin increases due to the destruction of stratum corneum. The deeper the wound the longer stratum corneum takes to normalize. Skin hydration also affects the skin elasticity, Scar maturity is related to the oxygen tension present transcutaneusly.[2]
Methods | Use |
---|---|
Tewameter (Courage+Khazaka Electronic GmbH, Cologne, Germany) measures the skin hydration and rate of oxygen diffusion | Useful in conducting research, however are noninvasive, commercially available. |
Standardized outcomes[edit | edit source]
Burns scar index (vancouver Scar scale): Measures Pliability, pigmentation, vascularity and height
Hamilton scale: Proportion of irregular scar with its height, depth, color, vascularity and numerical scar rating scale
Numerical scar rating scale: Border height of the scar, scar stiffness, color difference and the thickness of the scar.
Scar Management[edit | edit source]
Aim: Altering the physical an mechanical properties of the scar by influencing the scar maturation process. Also promoting tissue strength and gliding by preventing adhesions.