Scar and its management

What is a scar? | Scar management | Cosmetic camouflage



If you have sustained a burn injury, you may develop a hypertrophic scar. The burn staff will let you know when it becomes evident, usually 4 weeks or more from the time of injury. The hypertrophic scar will progress over the following months. This type of scarring tends to occur where there is tension on the wound, especially around the joints where contracture may result.
The chances of developing hypertrophic scars are higher if the burn wound was infected or did not close in around 3 weeks.


Scars affect different aspects of your life such as: function, appearance and self-confidence, interaction with other people, family and partner.
Worldwide, wound healing research programs are trying to find solutions for a better scar.
Nowadays, there is a variety of methods to decrease and to control scar formation. You may use one or more of these methods to improve your scar appearance.
It is important to review the scars repeatedly in order to assess how they respond to different methods of treatment. Scar formation is a dynamic process that takes up to 18 months, or until the maturing process is complete.
The Vancouver Scar Scale is a commonly used assessment tool and includes the physical (size, shape, colour, texture) and mechanical characteristics of a scar.



There is a lot to be discussed about scar formation and how scar matures.
You have to be aware that there is as yet no treatment that will get rid of scar completely, not even surgery. You may have the scar(s) for the rest of your life. With present methods, we can improve the texture, the appearance and the function of the involved area

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Scar after skin graft

Scar after deep burn


Non surgical methods involve the usage of pressure garments, topical products, massage and injection of steroids. All these methods aim to soften the scar, make it more pliable and to reduce the scar formation. Their success differs from person to person and you may use more than one method to control the scar formation.


The surgeons can get rid of a large scar but will replace it with another scar which may be an improvement. Surgery definitely has an important role in regaining the function in areas around joints where contractures are present.

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The scar formation process takes up to 12 - 18 months. During the acute phase, different non-surgical methods can control and reduce the scarring process. Surgical options will be taken into consideration when the scar will be mature enough.


Once your scar is healed and strong to resist pressure, massage should be incorporated into scar management. Frequent massage of the affected areas showed good results in preventing contractures and making the scar softer and more pliable. A deep massage breaks down the underlying tissue and stretches fresh scars.
Massage with moisturizing cream reduces the itchiness and the pain by a desensitizing process. Scar massage is performed two or three times a day and combines with other methods (physical therapy, pressure garments, silicone gel).



Physical exercise is an integral part of burn rehabilitation and should start while you are in the hospital as soon as possible. The aim of the physical exercise is to maintain and improve the functionality of the burned areas and to maintain the total body strength during the hospital stay and the recovery period. Physiotherapist will see you the next day after admission and will establish a plan with exercises tailored to your needs. The physiotherapist will teach you these exercises, which you could be able to perform later on, without supervision.
Your input and cooperation is important for us and for your rehabilitation process, especially while you are at home. New exercises will be added to increase the range of movements, mobility and to prevent contractures.

Walking is a considered as a physical exercise and may represent the primary goal if you have sustained large burns. For patients with less severe burns, walking will help them to return to an active lifestyle and will prevent weakening of the muscles.
If you have sustained burns to your extremities, they will be swollen for the next few months and exercises will try to reduce the swelling. Other benefits of physical therapy are:
O Maintain and improve the function of the involved joints,
O Maintain the muscle strength,
O Decrease the incidence of blood clots in your veins, and
Improve the bone density.

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Wound healing with scar formation


Silicone gel was used for management of scars since early 1980's.
Several studies have tried to explain how silicone gel works, but without success. The way that silicone interacts with the scar differs if it is a gel or a sheet. Scar hydration may be one of the mechanisms. At present, there are a variety of silicone gel products on the market with different composition and adhesion.
Silicone applied regularly and for a certain period of time tends to soften and flatten the scar. Silicone can be applied as a gel or as sheets when it is held in place with various devices (bandage, elastic bands, tapes or pressure garments). Form-fitted silicone gel sheet worn for at least 18 hours a day for several months appeared to decrease the hypertrophic scars.


Silicone gel is transparent and does not cause pain when it is applied to the skin. Silicone gel should be applied twice a day on the burn scars after adequate wash with water and mild soap. Before application, the area should be dry. A very thin coat of silicone gel should be applied gently over the scar and should be left for at least 5 minutes before covering with clothes / bandages/ pressure garments or make-up. The minimum period for treatment for obvious benefits is 2 months.

Do not apply the gel if there are open wounds or around the eyes.

ange in appearance and strength for the next 6 to 18 months.

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Hypertrophic scars tend to be itchy, painful, red and raised. Steroids injected under pressure into the scar may reduce the itch, take away the pain and soften the scar. The injections need to be repeated up to 3 to 4 times.
The injections are fairly limited by the small quantity of steroids that can be injected in one session. They are more effective in relatively small scars.
General anaesthetic may be necessary when injecting larger areas or in children.
Complications may include systemic absorption, pain on injection and can cause thinning of surrounding skin if the steroid spreads to normal tissue.

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If you have sustained relatively deep burns, the normal pressure of outer skin layer on the underlying tissue is lost and the scarring process persists in an uncontrolled manner for months.
In the last 20 years, fitted elastic garments were designed to generate a pressure of about 24 mm Hg in order to minimize the overscarring after a burn injury.

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