Scar Management: Difference between revisions
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Temperature | '''Temperature''' | ||
The temperature of a scar is depedant o the vasularity and amount of metabolic activity | |||
Subjective measures: | Subjective measures: | ||
Revision as of 11:28, 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:
| 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 depedant o the vasularity and amount of metabolic activity
Subjective measures:
Normal would healing[edit | edit source]
Collagen fibers synthesized are produced as a weak, random, bulky fires, these fibers would remodel based on the lines of tension. This poses the risk of adhesions and contracture
