Scar Management in Burns

Question 1

Which types of burns scar?

Answer 1

• Superficial: Heal <14 days, no scarring, sun care & moisturise
• Partial thickness: Heal 14-21 days may scar, >21 days likely scar
• Full thickness: Definitely will scar, should be grafted

Question 2

What is a scar?

Answer 2

• When healed burn goes into state of “over drive”
• Initially pink, flat, soft
  2-4 weeks increasing vascularity
• Delivering new skin tissue: fibrocytes collagen etc
  In a distorted knotty fashion

Question 3

Why should hypertrophic scarring be managed?

Answer 3

• Prevent contracture
• Increase independence
• Maximise function
• Decrease need for reconstructive surgery
• Attain best cosmetic results possible

Question 4

When should scar management be considered based on time to heal?

Answer 4

• <2 weeks: Unlikely to scar
• 2-3 weeks: Possibility of scarring
• > 3 weeks: Highly likely to scar

Question 5

When should scar management be considered based on pigment risk?

Answer 5

• Dark skin
• Pale skin/red hair
• Adolescents
• Pregnant women

Question 6

When should scar management be considered based on body site?

Answer 6

• Sternum

- Soft tissue areas e.g. inner thigh

Question 7

What are the characteristics of an active scar & how are they managed?

Answer 7

• Raised: Press
• Hardened & dried: Soften & moisturise
• Contracted: Stretch

Question 8

How does pressure work in scar management?

Answer 8

• Physically prevents raising by blanching or dampening blood flow and limiting the deposition of scar tissue
• Assists with collagen remodelling
• Applied at 25-40mmHg pressure continuously until scar maturation (except for removal for bathing)

Question 9

What are the benefits of pressure therapy?

Answer 9

• Flatten and soften hypertrophic scarring
• Reduce itching
• Normalise skin colour
• Help maintain joint range of motion and prevent contractures
• Provide a protective shield to new scar tissue
• Relieve “pain” over scar area

Question 10

What are the indications for silicone gel?

Answer 10

• Discreet scar areas
• Dense scar over joint surfaces
• Scar band contractures
• Dry and flaky skin with hypertrophy

Question 11

What are the precautions for silicone gel?

Answer 11

• Excessive moisturiser under silicone
• Unhealed wounds
• Skin reactions

Question 12

What are the strategies to soften & protect scars?

Answer 12

• Replace lost moisture (e.g. sorbolene)
• Use silicone gel sheets, hydrocolloid dressings or inserts for softening
• Protect from sun

Question 13

What are the benefits of inserts?

Answer 13

Beneficial for thick, rigid scars that are not located over joints and particularly in concave areas

Question 14

What is the effect of the sun on new skin?

Answer 14

• Hyper pigmentation
• Re-burning by damaging new skin cells
• Increase chances of malignant melanoma

Question 15

How can new skin be protected from sun damage?

Answer 15

• Sunscreen 30+ every 1-2 hours (including under compression garments)
• Hat and protective clothing

Question 16

How can new skin be protected from chemical damage?

Answer 16

• Avoid chlorinated swimming pools for 6 months post burn

- Wear appropriate grade of disposable gloves or protective clothing

Question 17

What is the effect of cosmetics & makeup on new skin?

Answer 17

• Cover make up can help with building confidence
• Disguise hyper or hypo pigmentation
• Cover redness, especially used for faces
• Changes to pigmentation more obvious in people with darker skin

Question 18

How is scar maturation seen clinically?

Answer 18

• Progressive remodeling of the scar
• Softening
• Flattening
• Decrease in wound tension
• Progressive devascularisation from red to white in colour