Vita TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
After discussing considerations for scar stability and effective intervention and how to choose among different interventions for pressure therapy for burn scars when scar stability is not optimal, we continue to discuss scar stability considerations for using pressure therapy by delving deeper into how to balance the need for pressure therapy for burn scars (scar control), with the need to protect fragile and unstable scars.
Do you still remember the scar in Picture 1? The scar appears to be unstable, and there are also local wounds. Can pressure therapy be used? How to choose the type of intervention?
At this stage, pressure therapy tools with low requirements for skin stability should be selected. Because the burn is located on the hand, self-adherent elastic bandages like Coban are a recommended option. If you are still worried about friction on the skin, non-woven gauze can be used to protect the fingers and the dorsal side of the hand. Then, self-adherent elastic bandage can be wrapped over the non-woven gauze. The non-woven gauze material is fine and can reduce friction on the skin.
Why is early use of pressure therapy for burn scars necessary?
Faced with fragile, unstable scars, the therapist may ask: Is it necessary to rush into using pressure therapy? Can't we wait until the scar stabilizes a bit before using it? The current discussion pertains to the issue of scar instability after wound closure, and we focus on the remodeling phase, which is the phase characterized by scar hypertrophy.
Firstly, providing pressure therapy as early as possible is essential to prevent contracture and control scar hypertrophic growth.
Secondly, the condition of scar instability may persist for several weeks, even months. It's not feasible to wait until the scar stabilizes completely before initiating pressure therapy, nor can we wait until scar hypertrophy has already begun to do a pressure therapy assessment. It's crucial to identify appropriate pressure therapy options based on the patient’s situation as early as possible.
Also consider edema in your pressure therapy assessment
Another important consideration is to pay special attention to edema, especially for the hands. In the article It’s not just swelling… Why you should pay close attention to edema of the hand, the potential problems caused by hand edema are mentioned, and the use of pressure therapy is one of the methods to control edema. If a patient has edema along with scar treatment needs, finding suitable pressure therapy options early can aid in rehabilitation progress. For more details on edema assessment, please refer to the edema management course.
Taking the hand in Picture 2 as an example, the scar is unstable, it seems prone to blistering upon friction. Some blisters and small wounds are already visible. The skin folds are not very obvious, indicating hand edema. Additionally, scar contracture restricts joint movement. A pressure therapy intervention is necessary.
As mentioned in Part 1 of this series, self-adherent elastic bandages can be used for scars at different stages. Therefore, for the hands in Picture 2, self-adherent elastic bandages can be used as a pressure therapy option. However, in this patient’s case, pressure therapy may need to be applied for at least a year, therefore in the long run, pressure gloves are still a more convenient option. Our approach is to initially use self-adherent elastic bandages and then begin the process of measuring and making customized pressure garment gloves. It takes several weeks between the time of measurement to garment delivery, so self-adherent elastic bandage is a temporary solution. Once the patient receives his garments, additional protective layer of non-woven gauze can be provided over vulnerable areas, and pressure gloves can be used.
To summarize…
Reminders that can help balance considerations between scar protection and scar control
During the remodeling phase of wound healing, the epidermis is indeed still very fragile, but using pressure therapy to prevent scar hypertrophy is also necessary. In situations where concerns arise about potential damage to fragile scar from pressure and friction, the following reminders can help balance considerations between scar protection and scar control:
Appropriate pressure: Choose suitable pressure therapy tools, ensuring that the pressure generated, regardless of the type used, is evenly distributed to avoid excessive localized pressure.
Regular skin inspection: Continuously observe the condition of the scar. If you notice inappropriate pressure marks, redness, pain, or other abnormalities, cease usage immediately and further assess the situation.
Maintain skin cleanliness and moisture: Pay attention to keeping the skin clean and moisturized, as it contributes to maintaining skin health.
Continuous professional assessment and monitoring: Pressure therapy tools should be used under professional assessment and guidance of the therapist, who should closely monitor the patient. Immediate response to the application of pressure should be observed after 30 minutes of usage. Once the patient has returned home, usage can be monitored over the course of a week.
For a more comprehensive assessment of pressure therapy aids for hands, please refer to the online course Rehabilitation of the Burned Hand: Pressure Therapy Interventions. In subsequent articles, further introduction of the application principles of pressure garments, self-adherent elastic bandages, elastic bandages, silicone gel sheets, and silicone clay pressure inserts will be discussed.
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