Scar Managementt

SCARS
TYPES & MANAGEMENT

Dr. Qurat Ul Ain Khan
Teaching Assistant, IPM&R
SCAR
 A scar is defined as the residual visible mark of a wound. It’s an area of fibrous tissue that
replaces normal skin after injury.
 A wound becomes a scar at the time that it is epithelialised. In the early stage, the
epithelium is thin and easily damaged by accidental abrasion. As time advance the scar
remains red for some months until it gradually pales; a process clinically described as
maturation.
HOW DOES SCARRING HAPPEN?
 A natural process during wound healing after an injury.

 Appearance and treatment depend on various factors;
 Depth and size of the wound/cut
 Location of injury
 Genetic makeup
 Age & gender
 Ethnicity
TYPES OF SCARS
 Mature scar- a flat scar that is light in color

 Immature scar- elevated, red, painful and itchy
 Keloid scar-are the result of an overly aggressive healing process extending
beyond the injured area (ear piercing)
 Hypertrophic scar-raised, red scars similar to keloid scar but does not
extend beyond the injured area
 Contracture-seen after burn injuries affecting mobility and may go deep to
the nerves and muscles
 Acne scar- any type of acne can leave a scar- various treatment options
available
PHYSIOTHERAPY MANAGEMENT OF SCARS:
 IT INVOLVES :
 Continuous Compression
 Thread-like shower
 Massage
 Vacumobilization
CONTINUOUS COMPRESSION:
 It is the most effective way of treating keloid scars.
 It works by gradually reducing scar that has not yet reached

maturity by preventing disordered clogging of collagen fibers. They
become linearly aligned as in adult scars.
 Continuous compression acts directly on collagen keeping the

fibers parallel, as in normal tissue. There is thus a reduction in
fibroblast proliferation and collagen production by capillary
compression.
THREAD-LIKE SHOWER
 It is a relatively recent technique of proven efficacy in treating
hypertrophic and keloid scars. These showers are water massages that
work using a nozzle whose pressure can be varied according to the
effect required, producing:
 - a light massage, carried out at low pressure
 - percussion, at average pressure, producing clearly defined, rapid,

intense redness
 - abrasion to thoroughly scrub the skin. The purpose of this procedure is to

remove waste products, and it must be carried out very carefully.
 Threadlike showers have two effects:
 chemical: through high-pressure water penetrating into the skin,
 mechanical: through micro-massage producing reflex vasodilatation and

longitudinal restructuring of elastic and collagen fibers
MASSAGE:
 It is very effective for treating scars.
 It involves:
 Jacquet-Leroy pinching plus torsion. This rapid movement is

performed, using each hand alternately, by simultaneously pinching and
pulling the skin between the flesh of the thumb and second finger
(principle of snapping one's fingers). This technique is used in both the
areas surrounding the scars and on the scar itself (pinching twisting).
 Kneading using two fingers along the whole length of the scar producing
stretching in all its segments.
 it's a dry (or non-oil), deep tissue facial massage that uses small
kneading and pinching movements
 Working on dry skin, a session can take from a few minutes to an

hour. Using their thumbs and index or middle fingers, the therapist
performs quick pinching movements with their fingertips. These rapid
movements oxygenate skin tissue, boosting circulation and cellular
activity in the process. Facial muscles are warmed up and
stimulated, making them more toned, firm and plump.
CONTINUE…..
 Ortho dermic stretching: "putting sustained pressure with the

fleshy side of the fingers of each hand on the small area treated
and then stretching the skin on both sides of the starting point. This
mobilization combats retraction.
VACUMOBILIZATION:
 It is the best technique currently available for the circulation in

functional terms of its anti fibrotic and anti retraction effects.
 It consists of using the vacuum created by suction and combining

it with the techniques mentioned above. It is obvious the
combination of all these procedures with the vacuum produced
considerably increases both the mechanical and circulatory
effects.
CONTINUE…
 In linear scars, use a small diameter suction pad (less than 10 mm) held
between the thumb and index finger, to very precisely reproduce the
movements. The suction power is adapted to the patient's sensitivity, age
of the scar, location, type and, lastly, the effect required.
 Palpation plus rolling is achieved when moving the suction pad by rolling
the skin under the edges of it.
 Kneading is carried out by stretching the scar transversally with traction in

the opposite direction (performed with two fingers).
 Pinching plus turning is carried out by applying the suction pad locally
which is then lifted and twisted at the same time

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SCARS

TYPES & MANAGEMENT

 A natural process during wound healing after an injury.

 Mature scar- a flat scar that is light in color

 It works by gradually reducing scar that has not yet reached

 Continuous compression acts directly on collagen keeping the

 - a light massage, carried out at low pressure

 - percussion, at average pressure, producing clearly defined, rapid,

 - abrasion to thoroughly scrub the skin. The purpose of this procedure is to

 chemical: through high-pressure water penetrating into the skin,

 mechanical: through micro-massage producing reflex vasodilatation and

 Jacquet-Leroy pinching plus torsion. This rapid movement is

 Working on dry skin, a session can take from a few minutes to an

 Ortho dermic stretching: "putting sustained pressure with the

 It is the best technique currently available for the circulation in

 It consists of using the vacuum created by suction and combining

 Kneading is carried out by stretching the scar transversally with traction in

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