University:
Swansea University
Course:
PM-139 | Human Physiology 1
Academic year:

2023
Views:

16

Pages:

5
Author:

Amal J.

SCAR Scar tissue is a non differentiated form of fibrous tissue which may develop some properties of the originated tissue but will not function in the same way as the normal tissue wound. Tissue proliferation (fibrous repair) 1-10 days + post injury Pathophysiology: Cellular phases during the stage include: → on going phagocytosis → angiogenests → proliferation of fibroblasts → production of collagen fibers [Initiated produced in an ordered and random fashion]. → absorption of inflammatory exudate Scar management: Following skin graft: After about 14 days the graft begins to contract and there is a danger. It will become adherent to underlying. Physiotherapy: Scar management techniques are required to maintain range of movement and soft tissue length. Complication arising from scar formation: 1) Adherence of graft to underlying 2) Contraction scar tissue 3) Hard immobile tissues 4) Red raised areas 5) Discomfort of tight skin 6) Persistent itching Objectives of physiotherapy: - Mobilize soft tissue - Increase active and passive range of motion - Prevent further contraction of the scar - Reduce redness and flatten raised areas - Lengthen soft tissue Treatment techniques: → Passive stretches → Massage → Pressure garments → Splintage Passive stretches: → PT performs gentle range of motion at the end of range to create a stretch to the scar. → Applied force will be controlled by the pain tolerance of the patient, the give of the tissue under stretch, and circulation to the area. → PT must observe the color changes of the scar carefully when a full stretch. It will blanch and this can be used as a guide to the effectiveness of the treatment when the scar tissue does not respond to repeated treatment or the contraction increases in tissues will require surgical release to regain the ROND. Massage: → Once the graft is stable and the edges fully healed, massage can be commenced. A moisturizing cream can be applied during this process. The massage should be initially carried out at the edges of the graft with small movements and superficial p° gradually work more centrally as the graft matures. → Avoid p° and sliding over the skin as this will cause blistering of the graft. The aim is to soften and mobilize the grafted tissue to enable freedom of movement, improve nutrition, and therefore restore function. Pressure garments: These are elastic garments which are fit to the patient's affected body segments which are constructed after measurements. They are worn nearly 24 hours a day and removed for washing and cream massage of the scars. They are used to reduce hypertrophic scarring (keloid) which is excessive, formation of collagen resulting in thick rope like uneven scars which both limit function and look unsightly. Pressure garments also assist in flattening raised areas and reducing the redness of the skin grafts. Pressure by an elasticated garment worn almost continuously for up to 2 yrs reduce the scarring. Individual assessment on a regular basis for adjustment to garment and shapes as the pt either groups or puts on weight. Different types of pressure garments: sleeves; tights, vests or glove, etc. to fitting into a concave area; silicone can be mailded to apply p° various products available to apply extra p° to concavity or persistent raised scaring.