Scar Management
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 bothe above and below the surface of the skin(depth of the scar) |
Colour
Pliability
Temperature
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
