Scar Process
If a wound has healed within two weeks without a skin graft then
it is unlikely to scar. The area may remain pink for some time but
this will gradually pale over several months. It is important to
keep the area well moisturised as it can become very dry and itchy.
If a wound has taken longer than two weeks to heal or has required
a skin graft there is an increased chance of developing
scarring.
Hypertrophic scarring
Hypertrophic scars are the result of an imbalance in the
production of collagen during the healing process. They are often
red, raised, firm and itchy but they do not extend beyond the
original boundary of the wound.
Keloid scars
A keloid scar is an overgrowth of tissue that occurs when too
much collagen is produced during the scarring process. This causes
the scar to continue to grow even after the wound has healed.
Scar management
If a wound has taken longer than two weeks to heal, it has been
grafted or there are any other risk factors associated with
scarring such as infection or family history your child will be
referred to the scar management team.
It is important to treat such scarring due to a number of
associated factors:
- The appearance of scars can be quite upsetting to some children
and prevent them from engaging in certain activities
- Scars over joints can become tight and prevent movement
- Scars can be painful, tight and uncomfortable
- Scars can be very dry and itchy and can cause problems with
sleep
- Scars can be very sensitive
Treatment
In order to minimise these affects a number of approaches and
treatments may be used:
- Moisturising
- Massage
- Using silicone sheets and gels
- Pressure garments
- Splints
- Exercise and stretches
Moisturisation
Scars and skin graft donor sites require regular creaming to
prevent the area from drying, cracking and becoming sore. This is
because newly healed skin is unable to lubricate itself in the same
way as undamaged skin. It is important to use a non-perfumed
moisturiser to keep the area soft and supple and prevent itching.
Perfumed creams can react with the newly healed sensitive scars.
Your therapist can provide you with some samples of creams if
needed. Moisturisers should be applied gently in thin layers while
the scars are more fragile and should be done 2-3 times a day. It
is important to fully cleanse the area each day to avoid build-up
of cream and skin irritation.
Massage
When the wound has healed we will advise you to commence gentle
massage called gliding. Prior to applying moisturiser place your
fingers onto the scar and move in gentle circular motions - you are
moving the skin not your fingers to prevent friction. Please ask
your therapist to demonstrate. Spend a few minutes using this
technique then apply the moisturiser. As the scar matures you can
increase the pressure of the massage to help soften scars. Your
therapist will guide you in this process as massaging too firmly
initially can make scarring worse.
Sun protection
As scars are extremely sensitive to sunlight and sun exposure it
is very important they are protected from the sun. Complete sun
block is recommended for at least two years following the injury.
Once the scars have matured we still recommend the damaged area of
skin is protected from the sun with at least a factor 30 sun cream.
Your therapist can give you some sample sun creams to try.
Silicone therapy
As new skin which has formed following the injury lacks the
moisture needed silicone acts by sealing in the moisture and
hydrating the scar. The aim of silicone is to flatten, soften
and pale the scar in addition to reducing discomfort. They are most
commonly used on small, stubborn scars or areas where it is
difficult to apply pressure such as the face. The use of
silicone will need to be reviewed regularly to check the
appropriateness and effectiveness of the treatment.
The most appropriate type of silicone for managing your child's
scar will be chosen by the therapist. You will also be given a
letter for your GP so you can get this on repeat prescription.
Silicone sheet(cica care/ dermatix)
- The sheet should be cut to size to cover the scar. The sheets
are usually self-adhesive but they may require further fixation
with a bandage or tape.
- The sheet should be washed daily in mild non oily soap, rinsed
in warm water, allowed to dry, and then re-applied. At the same
time the area of skin should be cleansed and dried as normal.
Moisturising cream should still be used but needs to be fully
absorbed before applying the sheet.
- The sheet should be worn for at least 12 hours a day and where
possible worn 24 hours a day.
- Your child will need to build up the wearing time slowly (see
wearing schedule below) to prevent the skin from reacting to the
silicone.
- When the sheet begins to deteriorate and cleaning becomes
difficult the piece should be replaced. Each piece should last for
up-to 6 weeks.
Example of initial wearing schedule for silicone sheets
| Day 1: 4
hours |
Day 4: 16 hours |
| Day 2: 8
hours |
Day 5: 20 hours |
| Day 3: 12
hours |
Day 6: 23 hours |
Silicone creams(scarsil, prosil, silgel)
- Silicone gel should be applied to the scar twice daily
- Before being apllied/re-applied the scar should be fully
cleaned as normal
- Continue to apply moisturising cream but allow this to fully
absorb before applying the silicone gel
Precautions
- Silicone should not be used on unhealed/open wounds
- In some cases a rash may occur. If this happens, make sure you
are fully cleaning the sheets and the skin regularly. Try and
reduce the length of time it is being worn.
- If the rash persists discontinue use and contact the scar
management team.
Silontex
This is a fabric backed silicone sheet that is stitched into a
pressure garment.
- It is only suitable to be used on small areas of scarring
- It is washed in the same way as described for your pressure
garment (see below)
- Silontex should not be used on unhealed or broken skin.
Pressure therapy(pressure garments)
Pressure garments are made-to-measure clothing, fitted
accurately to apply pressure to the scarred areas with the aim of
achieving scars that are flat, soft, pale and comfortable.
- The pressure garments should be worn up-to 23 hours a day
unless otherwise advised. They should only be removed for bathing
and creaming
- Initially you may need to slowly build up your child's
tolerance to the required wearing time.
- Progress of the scarring and the fit of the garments need to be
monitors carefully therefore regularly attending your child's
appointments is essential to achieve the best possible
outcome.
- You will need to return to the scar management clinic every
two-three months for your child to be re-measured.
- Garments should normally be received within 7-10 days from
order. Please contact the scar management team if the garment has
not arrived.
- When new garments are received old garments should be thrown
away as they are no longer effective
- It is still important to continue with cream and massage
- Garments do not protect from the sun's UVA rays so high factor
sun creams still need to be applied underneath the garments.
Washing instructions
- All garments must be either hand washed using a mild soap
product or washed in a delicate wash cycle
- Leave garments to air dry (to remove moisture you may wrap the
garment carefully in a towel)Do not use a tumble dryer or fabric
conditioner as this affects the elasticity of the garment
- If the garment has a foam pad insert, this needs to be washed
and dried separately.
Precautions
If any of the following problems occur please remove the garment
and contact the scar management team as soon as possible:
- Changes in circulation causing blueness or swelling in your
hands and feet
- Abnormal sensation/pins and needles
- Sore or broken skin
- Damage to your garment
