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PHYSICIAN'S PAGE

Management of Scars
By Bruce Smith, M.D., FACS

Scar Management and Reduction
with Tendra
Safetac Technology
by Mölnlycke







    Injuries that penetrate the thickest layer of the skin often result in the formation of scar tissue. Scars may follow a normal course of maturation and resolve to an acceptable state, or they can become abnormal. Any delay in healing may predispose a person to abnormal scar formation.

Hypertrophic or keloid scars are considered abnormal. Hypertrophic scars are raised, thick scars that do not extend beyond the border of the scar. Keloid scars invade into adjacent normal tissue with increased color, thickness and height. These scars are disfiguring and can lead to a decrease in function, especialy if the joints are involved. The aim of therapy is to soften, flatten, smooth out the scar and normalize the color of the scar.

Hypertrophic scars usually occur within the first six to eight weeks after the skin heals from an injury such as a burn or surgical incision. The scar continues to change or remodel over the next one or two years. Hypertrophic scars are more common when healing is delayed. The exact cause of this abnormal scarring is unknown. Keloid and Hypertrophic scars continue to be a widespread problem in particular for adult and child survivors of burns and individuals with darkly pigmentened skin.

Dermatologists and other cosmetic surgeons have an array of treatment options for improving the clinical appearance of hypertrophic and keloid scars. Recently, silicone gel sheeting has been found to prevent and improve these scars. Silicon gel sheets are thought to work by hydrating the scar tissue. Rehydration softens the scar, thereby making it more flexible and improving the natural repair and flattening process.

Other management techniques include further surgery, which may be self-defeating, especially when scarring results from previous surgical intervention. Pressure garments and the use of locally injected steroids (cortisone), surgical removal, radiation, emolients and massage, laser or cryotherapy therapy may also be used.

Silicon gel sheets are becoming the first line of management for hypertrophic and keloid scars because the therapy is relatively inexpensive and easy to use. New and long standing scars can be treated with silicone gel sheets. Silicon gel sheets are generally well tolerated and local skin irritation rarely occurs.

Mepiform with Safetec technology is a thin, flexible, self-adherent silicon dressing. This dressing can be applied, removed and reapplied to the scar area for comfortable scar care. It is used for the prevention and treatment of newly or previously developed hypertrophic and keloid scars. The consistent use of Mepiform will improve the scar’s appearance over time.

Because of the dressing’s high breathability, Mepiform helps prevent moisture buildup under the dressing so it can be worn longer while avoiding uncomfortable itchiness. The dressing is flexible, discreet and features a very low profile; therefore, it is easy to wear under clothing. Mepiform is waterproof and can be worn while bathing, showering or swimming. It can also be easily cut to fit almost any area of the body.

Bruce Smith, M.D., FACS is a board certified plastic surgeon at St. Joseph’s Hospital in Houston, TX.


IS THEIR ANY PUBLISHED LITERATURE TO SUPPORT THE USE OF SOFT SILICONE PRODUCTS?

Numerous papers have been published describing the properties of silicone and the use of soft silicone dressings. These include:

Dahlstrom KK. A new silicone rubber dressing used as a temporary dressing before delayed split skin grafting. A randomised study. Scand J Plast Reconstr Surg Hand Surg1995;29(4):325-27.

Dykes PJ, Heggie R, Hill SA. Effects of adhesive dressings on the stratum corneum of the skin. JWound Care 2001; 10(2): 7-10.

Dykes PJ, Heggie R. The link between the peel force of adhesive dressings and subjective discomfort in volunteer subjects. J Wound Care 2003; 12(7): 260-62.

Gotschall CS, Morrison MI, Eichelberger MR. Prospective, randomized study of the efficacy of Mepitel on children with partial-thickness scalds. J Burn Care Rehabil 1998; 19(4): 279-83.

Mustoe TA, Cooter RD, Gold MH, Hobbs FDR, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110(2):560-71.

Platt AJ, Phipps A, Judkins K. A comparative study of silicone net dressing and paraffin gauze dressing in skin-grafted sites. Burns 1996; 22(7): 543-45.

Meaume S, Van De Looverbosch D, Heyman H, Romanelli M, Ciangherotti A, Charpin SA. Study to compare a new self-adherent soft silicone dressings with a self-adherent polymer dressing in Stage II pressure ulcers. Ostomy Wound Management 2003; 49(9):44-51.

Vloemans AF, Kreis RW. Fixation of skin grafts with a new silicone rubber dressing (Mepitel). Scand J Plast Reconstr Surg Hand Surg 1994; 28(1): 75-76.

Williams C. Mepitel. Br J Nurs 1995; 4(1): 51-52, 54-55.

Young M, Robbie J. Case studies: use of Mepitel and Mepilex. Management of the diabetic foot: a guide to the assessment and management of diabetic foot ulcers. The Diabetic Foot 2002; 5(3): Suppl.


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