References

Anthonissen M, Daly D, Fieuws S, Massagé P, Van Brussel M, Vranckx J, Van den Kerckhove E Measurement of elasticity and transepidermal water loss rate of burn scars with the Dermalab®. Burns. 2013; 39:(3)420-428 https://doi.org/10.1016/j.burns.2012.07.026

Ault P, Plaza A, Paratz J Scar massage for hypertrophic burns scarring—A systematic review. Burns. 2018; 44:(1)24-38 https://doi.org/10.1016/j.burns.2017.05.006

Baryza MJ, Baryza GA The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995; 16:(5)535-538 https://doi.org/10.1097/00004630-199509000-00013

Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MWJ A new quantitative scale for clinical scar assessment. Plast Reconstr Surg. 1998; 102:(6)1954-1961 https://doi.org/10.1097/00006534-199811000-00022

Chae JK, Kim JH, Kim EJ, Park K Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar. Ann Dermatol. 2016; 28:(5)615-623 https://doi.org/10.5021/ad.2016.28.5.615

Choo AMH, Ong YS, Issa F Scar Assessment tools: how do they compare?. Front Surg. 2021; 8 https://doi.org/10.3389/fsurg.2021.643098

Chung BY, Kim HB, Jung MJ, Kang SY, Kwak IS, Park CW, Kim HO Post-Burn Pruritus. Int J Mol Sci. 2020; 21:(11) https://doi.org/10.3390/ijms21113880

Crowe JM, Simpson K, Johnson W, Allen J Reliability of photographic analysis in determining change in scar appearance. J Burn Care Rehabil. 1998; 19:(2)183-186 https://doi.org/10.1097/00004630-199803000-00019

Cubison TCS, Pape SA, Parkhouse N Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns. 2006; 32:(8)992-999 https://doi.org/10.1016/j.burns.2006.02.007

De Decker I, Hoeksema H, Vanlerberghe E Occlusion and hydration of scars: moisturizers versus silicone gels. Burns. 2022; S0305-S4172 https://doi.org/10.1016/j.burns.2022.04.025

Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J Hypertrophic burn scars: analysis of variables. J Trauma. 1983; 23:(10)895-898

Draaijers LJ, Tempelman FRH, Botman YAM, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PPM The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004; 113:(7)1960-1965 https://doi.org/10.1097/01.PRS.0000122207.28773.56

Due E, Rossen K, Sorensen LT, Kliem A, Karlsmark T, Haedersdal M Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. Acta Derm Venereol. 2007; 8:(7)

Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016; 388:(10052)1427-1436 https://doi.org/10.1016/S0140-6736(16)31406-4

Friedstat JS, Hultman CS Hypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials. Ann Plast Surg. 2014; 72:(6)S198-S201 https://doi.org/10.1097/SAP.0000000000000103

Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011; 17:(1-2)113-125 https://doi.org/10.2119/molmed.2009.00153

Hoeksema H, De Vos M, Verbelen J, Pirayesh A, Monstrey S Scar management by means of occlusion and hydration: A comparative study of silicones versus a hydrating gel-cream. Burns. 2013; 39:(7)1437-1448 https://doi.org/10.1016/j.burns.2013.03.025

Holavanahalli RK, Helm PA, Parry IS, Dolezal CA, Greenhalgh DG Select practices in management and rehabilitation of burns: a survey report. J Burn Care Res. 2011; 3:(2)210-23

Jiang Q, Chen J, Tian F, Liu Z Silicone gel sheeting for treating hypertrophic scars. Cochrane Database Syst Rev. 2021;

Kamolz LP, Jeschke MG Rehabilitation and scar management. In: Kamolz LP, Jeschke MG, Horch RE, Küntscher M, Brychta P Cham: Springer; 2020

Klotz T, Kurmis R, Munn Z, Heath K, Greenwood J Moisturisers in scar management following burn: A survey report. Burns. 2017; 43:(5)965-972 https://doi.org/10.1016/j.burns.2017.01.021

MacGill M Which sunscreen should I use. Medical News Today. 2018; https://www.medicalnewstoday.com/articles/306838

Masters M, McMahon M, Svens B Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS). J Burn Care Rehabil. 2005; 26:(3)273-284

McGrory C Reducing the impact of hypertrophic scarring. Wounds UK. 2013; 9:(3)18-22

Mecott GA, Finnerty CC, Herndon DN Reliable scar scoring system to assess photographs of burn patients. J Surg Res. 2015; 199:(2)688-697 https://doi.org/10.1016/j.jss.2014.10.055

Scar management practical guidelines. 2011;

Momeni M, Hafezi F, Rahbar H, Karimi H Effects of silicone gel on burn scars. Burns. 2009; 35:(1)70-74 https://doi.org/10.1016/j.burns.2008.04.011

Ngaage M, Agius M The psychology of scars: a mini-review. Psychiatr Danub. 2018; 30:(S7)633-638

Panyani AC, Reitblat C, Orgill DP Wound healing and scarring. Total scar management. 2020;

Parry I, Sen S, Palmieri T, Greenhalgh D Nonsurgical scar management of the face: does early versus late intervention affect outcome?. J Burn Care Res. 2013; 34:(5)569-575 https://doi.org/10.1097/BCR.0b013e318278906d

Pruksapong C Hand/peripheral nerve efficacy of silicone gel versus silicone gel sheet in hypertrophic scar prevention of deep hand burn patients with skin graft: a prospective randomized controlled trial and systematic review. Plast Reconstr Surg Glob Open. 2020; 1-9

Smith GM, Tompkins DM, Bigelow ME, Antoon AY Burninduced cosmetic disfigurement: can it be measured reliably?. J Burn Care Rehabil. 1988; 9:(4)371-375 https://doi.org/10.1097/00004630-198807000-00011

Sullivan T, Smith J, Kermode J, Mclver E, Courtemanche DJ Rating the burn scar. J Burn Care Rehabil. 1990; 11:(3)256-260 https://doi.org/10.1097/00004630-199005000-00014

Teot L, Otman S, Brancati A, Mittermayr R Burn scar treatment. Handbook of burns. 2020a; 2

Teot L, Otman S, Brancati A, Mittermayr R Burn wound healing: Pathophysiology. Handbook of burns. 2020b; 2

Trace AP, Enos CW, Mantel A, Harvey VM Keloids and hypertrophic scars: a spectrum of clinical challenges. Am J Clin Dermatol. 2016; 17:(3)201-223 https://doi.org/10.1007/s40257-016-0175-7

Van Loey NEE Psychological impact of living with scars following burn injury. Textbook on scar management. 2020;

Voight CD, Celis M, Voight DW Care of Outpatient Burns. Total burn care. 2018;

Yamawaki S Scar evaluation. Total scar management. 2020;

Yenikomshian HA, Gibran NS Burn wound healing and scarring pathophysiology. Total scar management. 2020;

Yeoung EK, Mann R, Engrav LH Improved burn scar assessment with use of a new scar-rating scale. J Burn Care Rehabil. 1997; 18:(4)353-355 https://doi.org/10.1097/00004630-199707000-00014

Yowler CJ, Coffee TL Outpatient burn management. Handbook of burns. 2020; 1

Hypertrophic scar management

02 March 2023
Volume 12 · Issue 2

Abstract

Scarring has major psychological and physical repercussions. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. It is more efficient to prevent hypertrophic scars than treat them; early diagnosis of a problem scar can considerably impact the overall outcome. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.

Over 100 million people develop scars in the developed world alone each year because of 55 million elective and 25 million trauma operations (Gauglitz et al, 2011). Wound healing is a complex process that is described as taking place over three main phases: inflammation, proliferation and remodelling. According to Trace et al (2016), it is during the remodelling phase that collagen deposition occurs in an organised fashion that results in a normal scar.

Abnormal scarring occurs when there is a disruption in this process that can lead to excess collagen synthesis and deposition that results in a hypertrophic scar (De Decker et al, 2022). During the formation of scars, the epidermal layers of the skin will produce high levels of moisture in an attempt to hydrate the scar site. However, most of this moisture evaporates once it reaches the stratum corneum, or upper layer of the skin; this is due to damage to the stratum corneum (De Decker et al, 2022). This moisture loss triggers keratinocytes in the skin to produce collagen, leading to this disruption.

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